Lowering Blood Pressure Improves Brain Hemorrhage Outcomes
FRIDAY April 4, 2008 -- Intravenous treatment to drastically lower the blood pressure of people who've just suffered bleeding in the brain may improve their prognosis, a pilot study suggests.
Intracranial hemorrhage often causes a rapid rise in blood pressure, which may contribute to further bleeding and the growth of the hematoma (an area of internal bleeding). This can cause the patient's condition to deteriorate and increase the risk of disability or death, according to background information in the study.
Although it's recommended to lower very high blood pressure as soon as possible in patients with intracranial hemorrhage, there is little evidence on when to start treatment or how much to lower blood pressure. This leads to wide variations in the management of high blood pressure in these patients.
This study compared intensive blood-pressure lowering treatment (target systolic blood pressure 140mm Hg) in 203 patients to the recommended best practice standard strategy (target systolic blood pressure 180 mm Hg) in 201 patients.
Brain scans conducted 24 hours after the start of treatment showed hematoma growth of 13.7 percent in the intensive treatment group, compared with 36.6 percent in the non-intensive group.
There were no differences between the two groups in terms of harmful side effects, rates of death and disability, or quality of life for survivors after 90 days.
"Because intravenous treatment to lower blood pressure is relatively straightforward, is not hazardous, and is of low cost, if applied widely, these effects could translate into major absolute benefits," concluded Dr. Craig Anderson, of the George Institute for International Health in Sydney, Australia, and colleagues.
The study was expected to be published in the May issue of The Lancet Neurology.
In the next phase of the trial, the researchers plan to assess how the intensive blood pressure-lowering treatment affects death and dependency in 2,800 intracranial hemorrhage patients worldwide.
In an accompanying Comment, Dr. Mustapha Ezzeddine, of the University of Minnesota, wrote that the study provides the best evidence to date of the safety of this kind of treatment.
However, many questions remain: Do the results apply to other stroke patients? How early and how long should blood pressure be controlled? Do different drugs have different effects?
The follow-up studies "are likely to answer some of these questions and, more importantly, to detect any effect on outcomes," Ezzeddine wrote.
Posted: April 2008