Title: BP Controversy: What's Ideal in ICH?

Category: Neurology

Keywords: Intracerebral hemorrhage, ICH, BP, variability, outcome (PubMed Search)

Posted: 8/28/2019 by WanTsu Wendy Chang, MD

Elevated BP is common with acute ICH and is associated with hematoma expansion and worse outcome.
Early BP lowering in ICH appear to be safe, though did not improve outcomes in the two largest trials INTERACT2 and ATACH-II.
A preplanned pooled analysis of 3829 patients from these 2 trials found:
- Every 10 mmHg reduction in SBP was associated with a 10% increase in odds of better functional recovery.
- Reduced variability of SBP was associated with improved outcomes.
The association between BP variability and outcomes in ICH has been observed in several other recent studies.

Bottom Line: Reduced SBP variability is associated with improved outcomes in ICH.

Moullaali TJ, Wang X, Martin RH, et al. Blood pressure control and clinical outcomes in acute intracerebral hemorrhage: a preplanned pooled analysis of individual participant data. Lancet Neurol 2019;18(9):857-64.
Chung PW, Kim JT, Sanossian N, et al. Association between hyperacute blood pressure variability and outcome in patients with spontaneous intracerebral hemorrhage. Stroke 2018;49(2):348-54.
Divani AA, Liu X, Di Napoli M, et al. Blood pressure variability predicts poor in-hospital outcomes in spontaneous intracerebral hemorrhage. Stroke 2019;50(8):2023-9.

Follow me on Twitter @EM_NCC