BP MANAGEMENT IN BRAIN BLEEDS

imagesThere´s a nice Best BET mini review in EMJ April 2016. The authors ask if it is safe and beneficial to control hypertension in the acute/hyperacute phase (~<6h from presentation) in patients with acute intracerebral haemorrhage.

Background
Roughly 10-30% of all strokes are acute bleeds. High BPs have been associated with  haematoma growth. Lowering BP, on the other hand, is controversial as many think hypertension is an adaptive response that maintains perfusion.

The study
The authors identified six papers of sufficient quality that represented the best available evidence of which four are highlighted.

The ICH ADAPT, INTERACT 1 and INTERACT 2 trials demonstrated how lowering SBP to < 140-150 mmHg was safe, perihematomal blood flow was preserved and did not increase mortality or rates of dependency or neurological deterioration when compared to standard treatment control groups ~ SBP <180).

However, only INTERACT2 could demonstrate a tendency towards improved functional recovery with intensive BP lowering (NNT=28 to avoid major disability or death).

Sakamoto et al. in the in the SAMURAI(!) study, reviewed 211 patients with ICH and hypertension with SBP > 180 mmHg who had nicardipine to achieve SBP < 160 mm Hg. The authors noted how functional 3 month outcomes were best in patients where SBP < 130 was achieved.

Take-home message
The Best-BET authors conclude lowering SBP in Screen Shot 2016-04-19 at 14.39.59the hyperacute/acute setting to < 140 is safe and may improve outcomes.

Study lives here:

Emerg Med J. 2016 Feb;33(2):159-62. doi: 10.1136/emermed-2016-205681.1. BET 1: Targeted blood pressure management in the hyperacute and acute stagesfollowing spontaneous intracerebral haemorrhage. Rajwani KM1, Nor AM1.

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