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A Prospective Multicenter Study to Evaluate the Feasibility and Safety of Aggressive Antihypertensive Treatment in Patients With Acute Intracerebral Hemorrhage

Institute of New Jersey, 90 Bergen Street, DOC-8100, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103-2425aiqureshi{at}hotmail.com

Yousef M. Mohammad, MD

Cleveland OH, and University of Mississippi; Jackson, MS

Abutaher M. Yahia, MD

Zeenat Qureshi Stroke Reseach Center, the Department of Neurology and Neurosciences

Jose I. Suarez, MD

The University of Medicine and Dentistry of New Jersey, Newark, NJ; Departments of Neurology at University Hospitals of Cleveland

Amir M. Siddiqui, MD

Zeenat Qureshi Stroke Reseach Center, the Department of Neurology and Neurosciences

Jawad F. Kirmani, MD

Zeenat Qureshi Stroke Reseach Center, the Department of Neurology and Neurosciences

M. Fareed K. Suri, MD

The University of Medicine and Dentistry of New Jersey, Newark, NJ; Departments of Neurology at University Hospitals of Cleveland

James Kolb, MD

Cleveland OH, and University of Mississippi; Jackson, MS

Osama O. Zaidat, MD

The University of Medicine and Dentistry of New Jersey, Newark, NJ; Departments of Neurology at University Hospitals of Cleveland

The authors performed a multicenter prospective observational study to evaluate the feasibility and safety of intravenous antihypertensive protocol for acute hypertension in patients with intracerebral hemorrhage (ICH). Twentyseven patients with ICH and acute hypertension (mean age 61.37 ± 14.27; 10 were men) were treated to maintain the systolic blood pressure (BP) below 160 mm Hg and diastolic BP below 90 mm Hg within 24 hours of symptom onset. Neurological deterioration (defined as a decrease in initial Glasgow Coma Scale score= 2) was observed in 2 (7.4%) of 27 patients during treatment. Among patients who underwent follow-up computed tomography, hematoma expansion (more than 33% increase in hematoma size at 24 hours) was observed in 2 (9.1%) of 22 patients. Patients treated within 6 hours of symptom onset were more likely to be functionally independent (modified Rankin scale–= 2) at 1 month compared with patients who were treated between 6 and 24 hours (8 of 18 versus 0 of 9,P= .03). Aggressive pharmacological treatment of acute hypertension in patients with ICH can be initiated early with a low rate of neurological deterioration and hematoma expansion.

Key Words: intracerebral hemorrhage • hypertension • labetalol • computed tomographic scan • neurological deterioration

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