The Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial

Background and Purpose-Acute blood pressure (BP) reduction aimed at attenuation of intracerebral hemorrhage (ICH) expansion might also compromise cerebral blood flow (CBF). We tested the hypothesis that CBF in acute ICH patients is unaffected by BP reduction. Methods-Patients with spontaneous ICH <24 hours after onset and systolic BP>150 mm Hg were randomly assigned to an intravenous antihypertensive treatment protocol targeting a systolic BP of <150 mm Hg (n=39) or <180 mm Hg (n=36). Patients underwent computed tomography perfusion imaging 2 hours postrandomization. The primary end point was perihematoma relative (relative CBF). Results-Treatment groups were balanced with respect to baseline systolic BP: 182 +/- 20 mm Hg (<150 mm Hg target group) versus 184 +/- 25 mm Hg (<180 mm Hg target group; P=0.60), and for hematoma volume: 25.6 +/- 30.8 versus 26.9 +/- 25.2 mL (P=0.66). Mean systolic BP 2 hours after randomization was significantly lower in the <150 mm Hg target group (140 +/- 19 vs 162 +/- 12 mm Hg; P<0.001). Perihematoma CBF (38.7 +/- 11.9 mL/100 g per minute) was lower than in contralateral homologous regions (44.1 +/- 11.1 mL/100 g per minute; P<0.001) in all patients. The primary end point of perihematoma relative CBF in the <150 mm Hg target group (0.86 +/- 0.12) was not significantly lower than that in the <180 mm Hg group (0.89 +/- 0.09; P=0.19; absolute difference, 0.03; 95% confidence interval -0.018 to 0.078). There was no relationship between the magnitude of BP change and perihematoma relative CBF in the <150 mm Hg (R=0.00005; 95% confidence interval, -0.001 to 0.001) or <180 mm Hg target groups (R=0.000; 95% confidence interval, -0.001 to 0.001). Conclusions-Rapid BP lowering after a moderate volume of ICH does not reduce perihematoma CBF. These physiological data indicate that acute BP reduction does not precipitate cerebral ischemia in ICH patients.