Intensive BP lowering may reduce  intracerebral bleeding, not stroke severity

A news study by a team of Yale researchers suggests that intensive blood pressure BP lowering may reduce hematoma expansion i.e the amount of bleeding in intracerebral hemorrhage but not over all prognosis.

The treatment of haemorhegic stroke due to spontaneous intracerebral hemorrhage that carries a 40% mortality rate is largely disappointing. The study has been published in the journal JAMA Neurology.

The researchers conducted the study to evaluate whether intensive blood pressure ,BP reduction decreases the risk of hematoma expansion and improve outcomes in patients with deep intracerebral hemorrhage or not.

In this exploratory analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage–2 randomized clinical trial, intensive blood pressure ,BP reduction was associated with a decreased risk of hematoma expansion in deep intracerebral hemorrhage, and this association was driven by hemorrhages located in the basal ganglia. No association with outcome was found in this population.

Intensive blood pressure reduction was associated with a decreased risk of hematoma expansion, an important neuroimaging marker of primary brain injury, in patients with intracerebral hemorrhage that compromises the basal ganglia; however, intensive blood pressure reduction was not associated with improved outcomes.

The researchers concluded that compared with standard treatment, intensive blood pressure BP, treatment was associated with reduced hematoma expansion in deep ICH, specifically among basal ganglia hemorrhages.

Although blood pressure reduction was associated with less ongoing bleeding, the analysis did not find an improvement in clinical outcomes. “This analysis demonstrates biological proof-of-concept of intensive blood pressure reduction as a therapy for intracerebral hemorrhage,” said Audrey Leasure, a second-year medical student at the Yale School of Medicine and lead author of the study. She said that larger studies of the subset of patients with damage to those areas of the brain may show improved therapeutic outcomes from intensive blood pressure reduction and that the specific location of brain injury should be incorporated into the design of future trials of brain hemorrhage.