Reader response: Blood pressure reduction and noncontrast CT markers of intracerebral hemorrhage expansion.

Abstract

We read with interest the article by Morotti et al.1 that suggested noncontrast CT (NCCT) markers are associated with outcomes but do not benefit from intensive blood pressure (BP) reduction in patients with intracerebral hemorrhage (ICH) undergoing medical treatments. We aimed to evaluate the role of NCCT markers in patients with ICH undergoing surgical treatment, which were reported in our study.2 A total of 201 patients were included with 25 rehemorrhages, 31 deaths at 3 months, 73 hypodensities, 35 black hole signs, 28 blend signs, 8 irregular shapes, 79 heterogeneous densities, and 76 satellite signs.3 After adjusting for the factors reported in Morotti et al.,1 the hypodensities (odds ratio [OR] 1.352, 95% confidence interval [CI] 1.169–1.564, p < 0.001), blend signs (OR 3.016, 95% CI 1.229–7.405, p = 0.016), and heterogeneous densities (OR 1.529, 95% CI 1.381–1.693, p < 0.001) were associated with rehemorrhage; moreover, the blend signs (OR 2.873, 95% CI 1.114–7.409, p = 0.029), irregular shapes (OR 2.305, 95% CI 1.184–4.487, p = 0.014), hematoma heterogeneous densities (OR 1.178, 95% CI 1.012–1.372, p = 0.035), and satellite signs (OR 1.642, 95% CI 1.237–2.179, p < 0.001) were associated with 3-month mortality. Intensive BP reduced the 3-month mortality in patients with blend sign (OR 0.557, 95% CI 0.326–0.951, p = 0.032). Thus, NCCT markers are associated with outcomes and benefited from intensive BP reduction in our cohort.