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.