Abstract
Background: Early treatment of elevated blood pressure (BP) in patients presenting
with spontaneous intracerebral hemorrhage (ICH) may decrease hematoma enlargement
and lead to better neurologic outcome. Study Objective: To determine whether early
BP control in patients with spontaneous ICH is both feasible and tolerated when initiated
in the Emergency Department (ED). Methods: A single-center, prospective observational
study in patients with spontaneous ICH was performed to evaluate a protocol to lower,
and maintain for 24 h, the mean arterial pressure (MAP) to a range of 100–110 mm Hg
within 120 min of arrival to the ED. An additional goal of placing a functional arterial
line within 90 min was specified in our protocol. Hematoma volume, neurologic disability,
adverse events, and in-hospital mortality were recorded. Results: A total of 22 patients
were enrolled over a 1-year study period. The average time to achieve our target MAP
after implementation of our protocol was 123 min (range 19–297 min). The average time
to arterial line placement was 84 min (range 36–160 min). Overall, 77% of the patients
tolerated the 24-h protocol. The in-hospital mortality rate in this group of patients
was 41%. Conclusions: Adopting a protocol to reduce and maintain the MAP to a target
of 100–110 mm Hg within 120 min of ED arrival was safe and well tolerated in patients
presenting with spontaneous ICH. If future trials demonstrate a clinical benefit of
early BP control in spontaneous ICH, EDs should implement similar protocols.
Keywords
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Article info
Publication history
Published online: March 16, 2009
Accepted:
February 5,
2009
Received in revised form:
November 7,
2008
Received:
August 26,
2008
Identification
Copyright
© 2011 Published by Elsevier Inc.
