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ICH ADAPT: Aggressive BP lowering after stroke appears safe

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Rapid, aggressive lowering of BP after intracerebral hemorrhage appears to be safe and does not reduce perihematoma cerebral blood flow, according to research presented at the International Stroke Conference 2013.

According to background information, one potential danger of lowering BP rapidly in patients with intracerebral hemorrhage (ICH) is compromise of cerebral blood flow in the region surrounding the hematoma. Kenneth S. Butcher, MD, PhD, assistant professor in the division of neurology at the University of Alberta, Canada, and colleagues reported that rapid BP lowering does not compromise this blood flow.

For the ICH ADAPT trial, researchers studied 75 patients with intracerebral hemorrhage and baseline BP >150 mm Hg. Patients were randomly assigned to IV antihypertensive therapy with labetalol, hydralazine and enalapril with a systolic BP target of <150 mm Hg or <180 mm Hg within 24 hours. They also underwent CT perfusion imaging 2 hours after randomization. The primary endpoint was relative cerebral blood flow within the 1 cm perihematoma region, according to the study abstract.

At baseline, the two groups were balanced in terms of systolic BP, hematoma volume and median time to randomization.

Two hours after randomization, mean systolic BP was significantly lower in the <150 mm Hg target group (140 mm Hg vs. 162 mm Hg; P<.001). Perihematoma cerebral blood flow decreased about 14% compared with contralateral homologous regions (38.7 mL/100 g per minute vs. 44.1 mL/100 g per minute; P<.001), according to a press release.

The researchers reported no difference in the primary endpoint between the <150-mm Hg or <180-mm Hg groups (0.86 vs. 0.89; P=.19). There was also no relationship between magnitude of BP change and perihematoma cerebral blood flow in either group. Treatment within 6 hours or 6 to 24 hours after onset had no effect on relative cerebral blood flow.

“These physiological data support the safety of acute and aggressive BP reduction following intracerebral hemorrhage,” Butcher and colleagues wrote in the abstract.

For more information:

Butcher KS. Abstract #113. Presented at: International Stroke Conference 2013; Feb. 5-8, 2013; Honolulu.

Disclosure: Butcher reports receiving research grants from the Alberta Innovates Health Solutions, Canada Research Chair, and Heart and Stroke Foundation of Canada.