The following is a summary of “Effects of Achieving Rapid, Intensive, and Sustained Blood Pressure Reduction in Intracerebral Hemorrhage Expansion and Functional Outcome,” published in the April 2024 issue of Neurology by Rodriguez-Luna et al.

Early blood pressure (BP) control in acute intracerebral hemorrhage (ICH) may be crucial for positive outcomes.

Researchers conducted a retrospective study investigating how quickly and effectively lowering systolic BP (SBP) impacted outcomes in acute ICH.

They conducted RAINS, a multi-center observational study over 4.5 years, involving adult patients with ICH within 6 hours of onset with SBP ≥150 mm Hg at 4 Comprehensive Stroke Centers. Patients received baseline and 24-hour CT scans and BP monitoring. BP was managed rapidly (≤60 minutes), intensively (target SBP <140 mm Hg), and sustainably (stable for 24 hours). SBP target achievement ≤60 minutes and 24-hour SBP variability were recorded. Outcomes included hematoma expansion (>6 mL or >33%) at 24 hours, early neurologic deterioration (END), and 90-day ordinal mRS score. Analyses adjusted for various factors.

The results showed 312 patients (mean age 70.2 ± 13.3 years, 202 [64.7%] male), 70/274 (25.6%) experienced hematoma expansion, while END occurred in 58/291 (19.9%), with a median 90-day mRS score of 4 (IQR, 2–5). SBP target achievement ≤60 minutes (178/312 [57.1%]) was associated with reduced risk of hematoma expansion (aOR 0.43, 95%CI 0.23–0.77), lower END rate (aOR 0.43, 95% CI 0.23–0.80), and better 90-day mRS scores (aOR 0.48, 95% CI 0.32–0.74). The mean 24-hour SBP variability was 21.0 ± 7.6 mm Hg. Higher 24-hour SBP variability was not linked to expansion (aOR 0.99, 95% CI 0.95–1.04) but correlated with increased END rate (aOR 1.15, 95% CI 1.09–1.21) and 90-day mRS scores (aOR 1.06, 95% CI 1.04–1.10).

Investigators concluded that aggressive systolic BP control in acute ICH was achieved rapidly and sustained within 24 hours, improving outcomes by reducing hematoma growth and enhancing clinical and functional recovery.

Source: neurology.org/doi/10.1212/WNL.0000000000209244