Blood pressure management in acute intracerebral haemorrhage: low blood pressure and early neurological deterioration

Abstract

Object. Lowering the blood pressure (BP) of patients with intracerebral haemorrhage (ICH) can prevent haematoma enlargement but may also promote secondary infarction in areas adjacent to the haematoma, which can lead to neurological deterioration. Little is known about the effects of low BP on early neurological deterioration (END). We conducted a retrospective study to determine whether low BP after admission was associated with END in patients with acute ICH.

Methods. We investigated 100 consecutive patients diagnosed with spontaneous ICH. We obtained data on minimum systolic blood pressure (SBP) in the 24 h after admission and related factors and assessed END in this time window.

Results. END occurred in 38 patients. The frequencies of END by minimum SBP quartile were 52% ( ≤ 100 mmHg), 29% (100–120 mmHg), 14% (120–130 mmHg), and 48% ( > 130 mmHg). A logistic regression model for predicting END was developed using SBP at admission, Glasgow Coma Scale at admission, haematoma volume, minimum SBP, and squared minimum SBP. A U-shaped relationship between minimum SBP and END (p = 0.02) was observed, with the lowest risk for END at a minimum SBP of 123 mmHg. The curve was nearly flat for a minimum SBP of 115–130 mmHg, indicating that the risk of END is relatively low across this range of minimum SBPs.

Conclusions. Our findings suggest that a minimum SBP of approximately 120–125 mmHg after admission is associated with a beneficial impact on a reduced risk of END.

Key words:

• Intracerebral haemorrhage
• blood pressure
• brain ischemia
• haematoma
• prognosis

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. Kazuhiro Ohwaki and Akira Tamura designed the study.