Intensive blood pressure reduction offers no added benefit in stroke outcomes

Standard blood pressure reduction is sufficient after intracerebral hemorrhage.
Standard blood pressure reduction is sufficient after intracerebral hemorrhage.

Intensive blood pressure reduction does not offer advantages compared with standard blood pressure reduction for patients with acute intracerebral hemorrhage, according to a study published in the New England Journal of Medicine.

Patients whose systolic blood pressure was reduced to the standard levels used to treat acute stroke (140 to 179 mm Hg) fared as well as patients who underwent intensive blood pressure reduction (110 to 139 mm Hg).

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"For decades, [clinicians] wondered whether intensive blood pressure management was more effective than standard treatment for controlling intracerebral hemorrhage," said lead researcher Adnan I. Qureshi, MD, from the Zeenat Qureshi Stroke Research Center at the University of Minnesota, Minneapolis. "Our results may help patients and their [clinicians] make better treatment decisions."

The study included 1,000 participants with intracerebral hemorrhage, a Glasgow Coma Scale score of 5 or higher, and a mean systolic blood pressure of 200.6 ± 27.0 mm Hg at baseline. Participants were randomly assigned to intensive treatment with a systolic blood pressure target of 110 to 139 mm Hg (n=500) or standard treatment with a systolic blood pressure target of 140 to 170 mm Hg (n=500). Primary outcomes were death and disability.

Primary outcomes were observed in 38.7% of participants in the intensive treatment group versus 37.7% in the standard treatment group. Serious adverse events that occurred with 72 hours of blood pressure reduction that were determined to be a result of treatment occurred in 1.6% of patients in the intensive treatment group and in 1.2% of those in the standard treatment group. The intensive treatment group had a significantly higher rate of renal adverse events within 7 days compared with the standard treatment group (9.0% versus 4.0%).

Reference

  1. Qureshi AI, Palesch YY, Barsan WG, et al. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Eng J Med. Published online June 8, 2016. doi:10.1056/NEJMoa1603460.
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