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- Elevated BP is common with acute ICH and is associated with hematoma expansion and worse outcome.
- Early BP lowering in ICH appear to be safe, though did not improve outcomes in the two largest trials INTERACT2 and ATACH-II.
- A preplanned pooled analysis of 3829 patients from these 2 trials found:
- Every 10 mmHg reduction in SBP was associated with a 10% increase in odds of better functional recovery.
- Reduced variability of SBP was associated with improved outcomes.
- The association between BP variability and outcomes in ICH has been observed in several other recent studies.
Bottom Line: Reduced SBP variability is associated with improved outcomes in ICH.
References
- Moullaali TJ, Wang X, Martin RH, et al. Blood pressure control and clinical outcomes in acute intracerebral hemorrhage: a preplanned pooled analysis of individual participant data. Lancet Neurol 2019;18(9):857-64.
- Chung PW, Kim JT, Sanossian N, et al. Association between hyperacute blood pressure variability and outcome in patients with spontaneous intracerebral hemorrhage. Stroke 2018;49(2):348-54.
- Divani AA, Liu X, Di Napoli M, et al. Blood pressure variability predicts poor in-hospital outcomes in spontaneous intracerebral hemorrhage. Stroke 2019;50(8):2023-9.
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