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Autoregulation of cerebral blood flow surrounding acute (6 to 22 hours) intracerebral hemorrhage.
Neurology. 2001 Jul 10; 57(1):18-24.Neur

Abstract

BACKGROUND

Arterial hypertension is common in the first 24 hours after acute intracerebral hemorrhage (ICH). Although increased blood pressure usually declines to baseline values within several days, the appropriate treatment during the acute period has remained controversial. Arguments against treatment of hypertension in patients with acute ICH are based primarily on the concern that reducing arterial blood pressure will reduce cerebral blood flow (CBF). The authors undertook this study to provide further information on the changes in whole-brain and periclot regional CBF that occur with pharmacologic reductions in mean arterial pressure (MAP) in patients with acute ICH.

METHODS

Fourteen patients with acute supratentorial ICH 1 to 45 mL in size were studied 6 to 22 hours after onset. CBF was measured with PET and (15)O-water. After completion of the first CBF measurement, patients were randomized to receive either nicardipine or labetalol to reduce MAP by 15%, and the CBF study was repeated.

RESULTS

MAP was lowered by -16.7 +/- 5.4% from 143 +/- 10 to 119 +/- 11 mm Hg. There was no significant change in either global CBF or periclot CBF. Calculation of the 95% CI demonstrated that there is less than a 5% chance that global or periclot CBF fell by more than -2.7 mL x 100 g(-1) x min(-1).

CONCLUSION

In patients with small- to medium-sized acute ICH, autoregulation of CBF was preserved with arterial blood pressure reductions in the range studied.

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Authors+Show Affiliations

Powers WJ
Department of Neurology and Neurological Surgery, Lillian Strauss Institute for Neuroscience, Washington University School of Medicine, St. Louis, MO 631101, USA. wjp@npg.wustl.edu
Zazulia AR
No affiliation info available
Videen TO
No affiliation info available
Adams RE
No affiliation info available
Yundt KD
No affiliation info available
Aiyagari V
No affiliation info available
Grubb RL
No affiliation info available
Diringer MN
No affiliation info available

MeSH

Acute DiseaseAdultAgedAntihypertensive AgentsBlood PressureCerebral HemorrhageCerebrovascular CirculationFemaleHomeostasisHumansLabetalolMaleMiddle AgedNicardipineTomography, X-Ray Computed

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

11445622

Citation

Powers, W J., et al. "Autoregulation of Cerebral Blood Flow Surrounding Acute (6 to 22 Hours) Intracerebral Hemorrhage." Neurology, vol. 57, no. 1, 2001, pp. 18-24.
Powers WJ, Zazulia AR, Videen TO, et al. Autoregulation of cerebral blood flow surrounding acute (6 to 22 hours) intracerebral hemorrhage. Neurology. 2001;57(1):18-24.
Powers, W. J., Zazulia, A. R., Videen, T. O., Adams, R. E., Yundt, K. D., Aiyagari, V., Grubb, R. L., & Diringer, M. N. (2001). Autoregulation of cerebral blood flow surrounding acute (6 to 22 hours) intracerebral hemorrhage. Neurology, 57(1), 18-24.
Powers WJ, et al. Autoregulation of Cerebral Blood Flow Surrounding Acute (6 to 22 Hours) Intracerebral Hemorrhage. Neurology. 2001 Jul 10;57(1):18-24. PubMed PMID: 11445622.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Autoregulation of cerebral blood flow surrounding acute (6 to 22 hours) intracerebral hemorrhage. AU - Powers,W J, AU - Zazulia,A R, AU - Videen,T O, AU - Adams,R E, AU - Yundt,K D, AU - Aiyagari,V, AU - Grubb,R L,Jr AU - Diringer,M N, PY - 2001/7/11/pubmed PY - 2001/8/3/medline PY - 2001/7/11/entrez SP - 18 EP - 24 JF - Neurology JO - Neurology VL - 57 IS - 1 N2 - BACKGROUND: Arterial hypertension is common in the first 24 hours after acute intracerebral hemorrhage (ICH). Although increased blood pressure usually declines to baseline values within several days, the appropriate treatment during the acute period has remained controversial. Arguments against treatment of hypertension in patients with acute ICH are based primarily on the concern that reducing arterial blood pressure will reduce cerebral blood flow (CBF). The authors undertook this study to provide further information on the changes in whole-brain and periclot regional CBF that occur with pharmacologic reductions in mean arterial pressure (MAP) in patients with acute ICH. METHODS: Fourteen patients with acute supratentorial ICH 1 to 45 mL in size were studied 6 to 22 hours after onset. CBF was measured with PET and (15)O-water. After completion of the first CBF measurement, patients were randomized to receive either nicardipine or labetalol to reduce MAP by 15%, and the CBF study was repeated. RESULTS: MAP was lowered by -16.7 +/- 5.4% from 143 +/- 10 to 119 +/- 11 mm Hg. There was no significant change in either global CBF or periclot CBF. Calculation of the 95% CI demonstrated that there is less than a 5% chance that global or periclot CBF fell by more than -2.7 mL x 100 g(-1) x min(-1). CONCLUSION: In patients with small- to medium-sized acute ICH, autoregulation of CBF was preserved with arterial blood pressure reductions in the range studied. SN - 0028-3878 UR - https://www.unboundmedicine.com/medline/citation/11445622/Autoregulation_of_cerebral_blood_flow_surrounding_acute__6_to_22_hours__intracerebral_hemorrhage_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=11445622 DB - PRIME DP - Unbound Medicine ER -