Intensive BP-lowering therapy safe for patients with acute ICH

Reducing systolic blood pressure (SBP) to a target of less than 140 mm Hg does not appear to have any negative effects on diffusion-weighted imaging (DWI) lesion frequency and volume in patients with acute intracerebral haemorrhage (ICH), as shown in ICHADAPT-2*.

ICHADAPT-2 included 162 patients with acute ICH who presented within 6 hours of onset. These patients were randomly assigned to undergo treatment with an acute SBP target of either <140 or <180 mm Hg. The primary endpoint was the incidence of acute DWI lesions on brain magnetic resonance imaging obtained 48 h after randomization.

A total of 79 patients (mean age 71 years, 48 percent female, median baseline ICH volume 11.2 mL) underwent DWI at 48 h and were included in the analysis. The median duration between onset and randomization was 3.17 h, while the median duration between onset and DWI was 51.6 h. Mean baseline SBP was 183 mm Hg in the <140-mm Hg target group and 181 mm Hg in the <180-mm Hg target group.

Over the 48-h period after randomization, mean SBP was significantly lower in the <140-mm Hg target than in the <180-mm Hg target group (mean difference, 18.9 mm Hg, 95 percent confidence interval [CI], 17.6–20.2; p<0.001). DWI lesions were detected in 13 of 42 patients (31 percent) in the <140-mm Hg target group and in 14 of 37 patients (38 percent) in the <180-mm Hg target group, with no significant difference (odds ratio, 0.74, 95 percent CI, 0.12–4.64; p=0.32).

Likewise, the <140- and <180-mm Hg target groups were similar in terms of the median number of DWI lesions (1 vs 1.5; p=0.26) and total DWI lesion volume (0.1 vs 0.3 mL; p=0.17).

The findings provide evidence of the safety of early intensive BP reduction in acute ICH.

*Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial 2