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Acute blood pressure reduction in patients with intracerebral hemorrhage does not result in borderzone region hypoperfusion.
Stroke. 2014 Oct; 45(10):2894-9.S

Abstract

BACKGROUND AND PURPOSE

The Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial (ICH ADAPT) demonstrated blood pressure (BP) reduction does not affect mean perihematoma or hemispheric cerebral blood flow. Nonetheless, portions of the perihematoma and borderzones may reach ischemic thresholds after BP reduction. We tested the hypothesis that BP reduction after intracerebral hemorrhage results in increased critically hypoperfused tissue volumes.

METHODS

Patients with Intracerebral hemorrhage were randomized to a target systolic BP (SBP) of <150 or <180 mm Hg and imaged with computed tomographic perfusion 2 hours later. The volumes of tissue below cerebral blood flow thresholds for ischemia (<18 mL/100 g/min) and infarction (<12 mL/100 g/min) were calculated as a percentage of the total volume within the internal and external borderzones and the perihematoma region.

RESULTS

Seventy-five patients with intracerebral hemorrhage were randomized a median (interquartile range) of 7.8 (13.3) hours from onset. Acute hematoma volume was 17.8 (27.1) mL and mean SBP was 183±22 mm Hg. At the time of computed tomographic perfusion (2.3 [1.0] hours after randomization), SBP was lower in the <150 mm Hg (n=37; 140±18 mm Hg) than in the <180 mm Hg group (n=36; 162±12 mm Hg; P<0.001). BP treatment did not affect the percentage of total borderzone tissue with cerebral blood flow<18 (14.7±13.6 versus 15.6±13.7%; P=0.78) or <12 mL/100 g/min (5.1±5.1 versus 5.8±6.8%; P=0.62). Similar results were found in the perihematoma region. Low SBP load (fraction of time with SBP<150 mmHg) did not predict borderzone tissue volume with cerebral blood flow<18 mL/100 g/min (β=0.023 [-0.073, 0.119]).

CONCLUSIONS

BP reduction does not increase the volume of critically hypoperfused borderzone or perihematoma tissue. These data support the safety of early BP reduction in intracerebral hemorrhage.

CLINICAL TRIAL REGISTRATION URL

http://www.clinicaltrials.gov. Unique identifier: NCT00963976.

Authors+Show Affiliations

From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.). ken.butcher@ualberta.ca.No affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

25147326

Citation

Gould, Bronwen, et al. "Acute Blood Pressure Reduction in Patients With Intracerebral Hemorrhage Does Not Result in Borderzone Region Hypoperfusion." Stroke, vol. 45, no. 10, 2014, pp. 2894-9.
Gould B, McCourt R, Gioia LC, et al. Acute blood pressure reduction in patients with intracerebral hemorrhage does not result in borderzone region hypoperfusion. Stroke. 2014;45(10):2894-9.
Gould, B., McCourt, R., Gioia, L. C., Kate, M., Hill, M. D., Asdaghi, N., Dowlatshahi, D., Jeerakathil, T., Coutts, S. B., Demchuk, A. M., Emery, D., Shuaib, A., & Butcher, K. (2014). Acute blood pressure reduction in patients with intracerebral hemorrhage does not result in borderzone region hypoperfusion. Stroke, 45(10), 2894-9. https://doi.org/10.1161/STROKEAHA.114.005614
Gould B, et al. Acute Blood Pressure Reduction in Patients With Intracerebral Hemorrhage Does Not Result in Borderzone Region Hypoperfusion. Stroke. 2014;45(10):2894-9. PubMed PMID: 25147326.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute blood pressure reduction in patients with intracerebral hemorrhage does not result in borderzone region hypoperfusion. AU - Gould,Bronwen, AU - McCourt,Rebecca, AU - Gioia,Laura C, AU - Kate,Mahesh, AU - Hill,Michael D, AU - Asdaghi,Negar, AU - Dowlatshahi,Dariush, AU - Jeerakathil,Thomas, AU - Coutts,Shelagh B, AU - Demchuk,Andrew M, AU - Emery,Derek, AU - Shuaib,Ashfaq, AU - Butcher,Ken, AU - ,, Y1 - 2014/08/21/ PY - 2014/8/23/entrez PY - 2014/8/26/pubmed PY - 2015/1/27/medline KW - cerebral hemorrhage KW - hypertension KW - perfusion imaging SP - 2894 EP - 9 JF - Stroke JO - Stroke VL - 45 IS - 10 N2 - BACKGROUND AND PURPOSE: The Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial (ICH ADAPT) demonstrated blood pressure (BP) reduction does not affect mean perihematoma or hemispheric cerebral blood flow. Nonetheless, portions of the perihematoma and borderzones may reach ischemic thresholds after BP reduction. We tested the hypothesis that BP reduction after intracerebral hemorrhage results in increased critically hypoperfused tissue volumes. METHODS: Patients with Intracerebral hemorrhage were randomized to a target systolic BP (SBP) of <150 or <180 mm Hg and imaged with computed tomographic perfusion 2 hours later. The volumes of tissue below cerebral blood flow thresholds for ischemia (<18 mL/100 g/min) and infarction (<12 mL/100 g/min) were calculated as a percentage of the total volume within the internal and external borderzones and the perihematoma region. RESULTS: Seventy-five patients with intracerebral hemorrhage were randomized a median (interquartile range) of 7.8 (13.3) hours from onset. Acute hematoma volume was 17.8 (27.1) mL and mean SBP was 183±22 mm Hg. At the time of computed tomographic perfusion (2.3 [1.0] hours after randomization), SBP was lower in the <150 mm Hg (n=37; 140±18 mm Hg) than in the <180 mm Hg group (n=36; 162±12 mm Hg; P<0.001). BP treatment did not affect the percentage of total borderzone tissue with cerebral blood flow<18 (14.7±13.6 versus 15.6±13.7%; P=0.78) or <12 mL/100 g/min (5.1±5.1 versus 5.8±6.8%; P=0.62). Similar results were found in the perihematoma region. Low SBP load (fraction of time with SBP<150 mmHg) did not predict borderzone tissue volume with cerebral blood flow<18 mL/100 g/min (β=0.023 [-0.073, 0.119]). CONCLUSIONS: BP reduction does not increase the volume of critically hypoperfused borderzone or perihematoma tissue. These data support the safety of early BP reduction in intracerebral hemorrhage. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00963976. SN - 1524-4628 UR - https://www.unboundmedicine.com/medline/citation/25147326/Acute_blood_pressure_reduction_in_patients_with_intracerebral_hemorrhage_does_not_result_in_borderzone_region_hypoperfusion_ L2 - http://www.ahajournals.org/doi/full/10.1161/STROKEAHA.114.005614?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -