The Unsolved Conundrum of Optimal Blood Pressure Target During Acute Haemorrhagic Stroke: A Comprehensive Analysis

Giuseppe Mule', Brigida Fierro, Santina Cottone, Giovanni Cerasola, Santina Cottone, Alessandra Sorce, Marta Giambrone, Giuseppe Mulè, Giovanni Cerasola, Marta Giambrone

Risultato della ricerca: Review article

1 Citazione (Scopus)

Abstract

Intracerebral haemorrhage (ICH) is a devastating cerebrovascular disease, which accounts to 15% of all strokes. Among modifiable risk factors for ICH, hypertension is the most frequent. High blood pressure (BP) is detected in more than 75–80% of patients with ICH. Extremely elevated BP has been associated with early hematoma growth, a relatively frequent occur-rence and powerful predictor of poor outcome in patients with spontaneous ICH. On the other hand, excessively low BP might cause cerebral hypoperfusion and ultimately lead to poor outcome. This review will analyse the most important trials that have tried to establish how far should BP be lowered during acute ICH. These trials have demonstrated either a small non-significant benefit (INTERACT-2, INTEnsive blood pressure Reduction in Acute Cerebral haemorrhage Trial) or no benefit (ATACH-2, Antihypertensive treatment of acute cerebral haemorrhage II study) when intensive systolic BP reduc-tion was compared with modest or standard BP reduction. The more recent meta-analyses including studies investigating this issue yielded similar conclusions: aggressive BP control in the acute phase of ICH is not beneficial. For these reasons the 2018 European Society of Cardiology/ European Society of Hypertension Guidelines for the management of arterial hypertension, do not recommend treatment to immediately lowerBPin patients with acute ICH and systolic BP < 220mmHg. Careful lowering of SBP to less than 180mmHg via i.v. Infusion may be considered only in patients with SBP ≥ 220mmHg.
Lingua originaleEnglish
pagine (da-a)119-126
Numero di pagine8
RivistaHIGH BLOOD PRESSURE &amp; CARDIOVASCULAR PREVENTION
Volume26
Stato di pubblicazionePublished - 2019

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Cerebral Hemorrhage
Stroke
Blood Pressure
Hypertension
Cerebrovascular Disorders
Hematoma
Hypotension
Antihypertensive Agents
Meta-Analysis
Guidelines
Therapeutics
Growth

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

Cita questo

The Unsolved Conundrum of Optimal Blood Pressure Target During Acute Haemorrhagic Stroke: A Comprehensive Analysis. / Mule', Giuseppe; Fierro, Brigida; Cottone, Santina; Cerasola, Giovanni; Cottone, Santina; Sorce, Alessandra; Giambrone, Marta; Mulè, Giuseppe; Cerasola, Giovanni; Giambrone, Marta.

In: HIGH BLOOD PRESSURE &amp; CARDIOVASCULAR PREVENTION, Vol. 26, 2019, pag. 119-126.

Risultato della ricerca: Review article

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title = "The Unsolved Conundrum of Optimal Blood Pressure Target During Acute Haemorrhagic Stroke: A Comprehensive Analysis",
abstract = "Intracerebral haemorrhage (ICH) is a devastating cerebrovascular disease, which accounts to 15{\%} of all strokes. Among modifiable risk factors for ICH, hypertension is the most frequent. High blood pressure (BP) is detected in more than 75–80{\%} of patients with ICH. Extremely elevated BP has been associated with early hematoma growth, a relatively frequent occur-rence and powerful predictor of poor outcome in patients with spontaneous ICH. On the other hand, excessively low BP might cause cerebral hypoperfusion and ultimately lead to poor outcome. This review will analyse the most important trials that have tried to establish how far should BP be lowered during acute ICH. These trials have demonstrated either a small non-significant benefit (INTERACT-2, INTEnsive blood pressure Reduction in Acute Cerebral haemorrhage Trial) or no benefit (ATACH-2, Antihypertensive treatment of acute cerebral haemorrhage II study) when intensive systolic BP reduc-tion was compared with modest or standard BP reduction. The more recent meta-analyses including studies investigating this issue yielded similar conclusions: aggressive BP control in the acute phase of ICH is not beneficial. For these reasons the 2018 European Society of Cardiology/ European Society of Hypertension Guidelines for the management of arterial hypertension, do not recommend treatment to immediately lowerBPin patients with acute ICH and systolic BP < 220mmHg. Careful lowering of SBP to less than 180mmHg via i.v. Infusion may be considered only in patients with SBP ≥ 220mmHg.",
author = "Giuseppe Mule' and Brigida Fierro and Santina Cottone and Giovanni Cerasola and Santina Cottone and Alessandra Sorce and Marta Giambrone and Giuseppe Mul{\`e} and Giovanni Cerasola and Marta Giambrone",
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AU - Mule', Giuseppe

AU - Fierro, Brigida

AU - Cottone, Santina

AU - Cerasola, Giovanni

AU - Cottone, Santina

AU - Sorce, Alessandra

AU - Giambrone, Marta

AU - Mulè, Giuseppe

AU - Cerasola, Giovanni

AU - Giambrone, Marta

PY - 2019

Y1 - 2019

N2 - Intracerebral haemorrhage (ICH) is a devastating cerebrovascular disease, which accounts to 15% of all strokes. Among modifiable risk factors for ICH, hypertension is the most frequent. High blood pressure (BP) is detected in more than 75–80% of patients with ICH. Extremely elevated BP has been associated with early hematoma growth, a relatively frequent occur-rence and powerful predictor of poor outcome in patients with spontaneous ICH. On the other hand, excessively low BP might cause cerebral hypoperfusion and ultimately lead to poor outcome. This review will analyse the most important trials that have tried to establish how far should BP be lowered during acute ICH. These trials have demonstrated either a small non-significant benefit (INTERACT-2, INTEnsive blood pressure Reduction in Acute Cerebral haemorrhage Trial) or no benefit (ATACH-2, Antihypertensive treatment of acute cerebral haemorrhage II study) when intensive systolic BP reduc-tion was compared with modest or standard BP reduction. The more recent meta-analyses including studies investigating this issue yielded similar conclusions: aggressive BP control in the acute phase of ICH is not beneficial. For these reasons the 2018 European Society of Cardiology/ European Society of Hypertension Guidelines for the management of arterial hypertension, do not recommend treatment to immediately lowerBPin patients with acute ICH and systolic BP < 220mmHg. Careful lowering of SBP to less than 180mmHg via i.v. Infusion may be considered only in patients with SBP ≥ 220mmHg.

AB - Intracerebral haemorrhage (ICH) is a devastating cerebrovascular disease, which accounts to 15% of all strokes. Among modifiable risk factors for ICH, hypertension is the most frequent. High blood pressure (BP) is detected in more than 75–80% of patients with ICH. Extremely elevated BP has been associated with early hematoma growth, a relatively frequent occur-rence and powerful predictor of poor outcome in patients with spontaneous ICH. On the other hand, excessively low BP might cause cerebral hypoperfusion and ultimately lead to poor outcome. This review will analyse the most important trials that have tried to establish how far should BP be lowered during acute ICH. These trials have demonstrated either a small non-significant benefit (INTERACT-2, INTEnsive blood pressure Reduction in Acute Cerebral haemorrhage Trial) or no benefit (ATACH-2, Antihypertensive treatment of acute cerebral haemorrhage II study) when intensive systolic BP reduc-tion was compared with modest or standard BP reduction. The more recent meta-analyses including studies investigating this issue yielded similar conclusions: aggressive BP control in the acute phase of ICH is not beneficial. For these reasons the 2018 European Society of Cardiology/ European Society of Hypertension Guidelines for the management of arterial hypertension, do not recommend treatment to immediately lowerBPin patients with acute ICH and systolic BP < 220mmHg. Careful lowering of SBP to less than 180mmHg via i.v. Infusion may be considered only in patients with SBP ≥ 220mmHg.

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