Neurology in critical care · Blood pressure in intracerebral haemorrhage
Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Intensive lowering to a systolic target of 110 to 139 mmHg |
| Control | Standard lowering to a target of 140 to 179 mmHg |
| Population | 1000 participants with intracerebral haemorrhage, mean systolic blood pressure 200.6±27.0 mmHg at baseline, mean age 61.9 |
| Follow-up | 90 days |
| Primary endpoint | Death or disability at 90 days, modified Rankin Scale 4 to 6 |
| Result | Treatment to a systolic target of 110 to 139 mmHg did not reduce death or disability compared with standard reduction to 140 to 179 mmHg, among 500 patients in each group. |
| Secondary endpoints | Haematoma expansion, renal adverse events, quality of life |
The treatment of participants with intracerebral hemorrhage to achieve a target systolic blood pressure of 110 to 139 mm Hg did not result in a lower rate of death or disability than standard reduction to a target of 140 to 179 mm Hg.
The trial authors, in the published abstract
Ends the argument for driving systolic pressure below 140 in acute intracerebral haemorrhage, with a hint of renal harm for the effort. A target under 140 remains reasonable; chasing 110 to 139 does not.
Qureshi AI, Palesch YY, Barsan WG, et al. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. N Engl J Med 2016 Sep 15;375(11):1033-43.