Blood pressure management in acute intracerebral hemorrhage - Relationship between elevated blood pressure and hematoma enlargement

Background and Purpose-The association between elevated blood pressure ( BP) and hematoma enlargement in acute intracerebral hemorrhage (ICH) has not been clarified. We investigated the association between maximum systolic BP (SBP) and hematoma enlargement, measuring SBP between a baseline and a second CT scan in patients with hypertensive ICH. Methods-We assessed 76 consecutive patients with hypertensive ICH retrospectively. We usually attempted to lower SBP below targets of 140, 150, or 160 mm Hg. Recordings of serial BP from admission until the second CT scan were assessed. A neuroradiologist, who was not informed of the aim of this study, reviewed CT films. Hematoma enlargement was defined as an increase in volume of greater than or equal to140% or 12.5 cm(3). Results-Hematoma enlargement occurred in 16 patients. Maximum SBP was significantly associated with hematoma enlargement (P = 0.0074). A logistic regression model for predicting hematoma enlargement was constructed with the use of maximum SBP, hematoma volume, and Glasgow Coma Scale score at admission. After adjustment for these factors, maximum SBP was independently associated with hematoma enlargement (odds ratio per mm Hg, 1.04; 95% CI, 1.01 to 1.07). Target SBPs of greater than or equal to160 mm Hg were significantly associated with hematoma enlargement compared with those of less than or equal to150 mm Hg (P = 0.025). Conclusions-Our findings suggest that elevated BP increases the risk of hematoma enlargement. Efforts to lower SBP below 150 mm Hg may prevent this risk.