Abstract T P235: Clinical Significance of Continuous Antihypertensive Therapy Throughout the Initial 24 Hours in Hyperacute Intracerebral Hemorrhage: The Samurai-ich Study

Abstract

BACKGROUND and PURPOSE: Blood pressure (BP) lowering may be beneficial for patients with hyperacute intracerebral hemorrhage (ICH). Although several trials including INTERACT 2 and ATACH II have a design of the strict BP lowering during the initial 24 hours, shorter duration may be enough since active bleeding may not last 24 hours. We aimed to examine the associations between sequential systolic BP levels during antihypertensive treatment (AHT) and clinical outcomes in acute ICH patients. METHODS: Hyperacute (180 mmHg were registered in a prospective, multicenter, observational study, the SAMURAI-ICH study (Koga J Hypertens 2012;30:2357). All patients received intravenous AHT, based on a predefined standardized protocol to lower and maintain SBP between 120 and 160 mmHg using intravenous nicardipine. BPs were measured hourly in the initial 24 hours. The mean of 8 SBP levels during 1 to 8, 9 to 16, and 17 to 24 hours after the initiation of AHT were calculated, and referred to as the 1st, 2nd and 3rd mSBPs, respectively. The associations between mSBPs and neurological deterioration (a decrease of ≥2 in GCS or an increase of ≥4 in NIHSS score), hematoma expansion (>33% in volume), and unfavorable outcome (modified Rankin Scale score 4-6 at 3 months) were assessed. RESULTS: 211 patients (81 women, median age 65 [IQR, 58-74] years, median initial NIHSS score 13 [8-17]) were included. The baseline hematoma volume was 10.2 (5.6-19.2) mL. Neurological deterioration was observed in 17 patients (8%), hematoma expansion in 36 (17%), and unfavorable outcome in 87 (41%). The 1st, 2nd, and 3rd mSBPs were 132 (126-138), 131 (125-140), and 137 (130-144) mmHg, respectively. The 1st (OR 2.41, 95%CI 1.34-4.69 per 10-mmHg) and 2nd mSBPs (2.08; 1.20-3.80) were independently associated with neurological deterioration (17 patients) and the 2nd (1.40; 1.02-2.00) and 3rd mSBPs (1.45; 1.05-2.05) were associated with unfavorable outcome (87 patients), although no mSBPs were associated with hematoma expansion (36 patients). CONCLUSIONS: Continuation of AHT throughout the initial 24 hours may ameliorate clinical outcomes.