An intracerebral hemorrhage (ICH), bleeding inside the brain caused by a ruptured blood vessel, can have devastating effects, seriously damaging the brain due to the sudden pressure, causing disability or even death. Elevated blood pressure levels at onset and in the days following have been linked to worse outcomes, so managing blood pressure is important. However, there is limited data available to help guide the choice of blood pressure goals, specifically systolic levels.
A consortium of researchers, including those from Baylor College of Medicine, are working to find more answers. In their latest research, published in the current edition of the New England Journal of Medicine, they found that when people suffering from ICH maintained a lower systolic level, the outcomes were the same when compared to the current systolic level goal.
“The target systolic blood pressure goal for someone with ICH is 140-180 mmHg. However, we found when pressure was brought down to a range of 110-140 mmHg, the outcomes were nearly the same,” said Dr. Jose Suarez, professor of neurology at Baylor and co-author of the study.
For an average healthy person, systolic blood pressure levels should be 90-120 mmHg. From that point to 140 mmHg is considered prehypertensive. A person is considered hypertensive, and at risk of heart attack or stroke, when levels are 140 mmHg to around 160mmHg. Once levels reach 180mmHg medical attention is needed immediately.
“We focused on the lower thresholds because of preliminary evidence that higher blood pressure thresholds were associated with growth of the intracerebral bleeding,” said Suarez. “Even though the patient outcomes were the same, the results are extremely important because they indicate that we can relax the blood pressure goals without causing harm to patients and instead focus on answering other questions.”
Those questions include finding other ways to relieve bleeding, such as minimally-invasive surgery. Suarez also said the findings will save time and healthcare costs since blood pressure treatment does not improve outcomes.
“The findings also stress the importance of conducting large clinical trials to answer important questions such as this one. All the data we had before came from smaller studies,” Suarez said.
A total of 1,000 people with ICH were monitored at 110 participating research sites across the globe, including Japan, China, Taiwan, South Korea and Germany.
Suarez added that a broader implication of the findings is that more large scale clinical trials and the public’s participation in clinical trials can answer more questions that affect larger populations.
Others who contributed to the study include Dr. Adnan Qureshi, principal investigator, from the University of Minnesota, the clinical trials section of the National Institute of Neurological Disorders and Stroke, The National Emergency Treatment Trials Network and the Neurocritical Care Research Network (NCRN). Suarez is chair of the NCRN.
Funding for the ATACH 2: Antihypertensive Treatment of Acute Intracerebral Hemorrhage study came from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health. The medication for blood pressure control was donated by CHIESI pharmaceuticals.