Table 2.
Relevant studies on hypertensive crisis and intracerebral hemorrhage.
| Study | Design | Patients n | Aim/Location | Main Findings |
|---|---|---|---|---|
| Anderson et al., 2008 [76] | Prospective randomized trial (INTERACT) |
404 | Lobar (9.0%), basal ganglia (82.5), brainstem (4.5%), cerebellum (4%), intraventricular extension (23.5%). | The relative risk of hematoma growth was lower with an intensive BP-lowering treatment. Clinical outcomes were not different with intensive blood-pressure-lowering treatment. |
| Koch et al., 2008 [77] | Prospective | 42 | Feasibility and safety of reducing BP to lower than presently recommended levels in acute ICH. | Aggressive lowering of BP did not affect hematoma, edema expansion, neurological deterioration, or outcome. |
| Suri et al., 2008 [78] | Retrospective | 122 | Drop in systolic BP and mean arterial pressures over 24 h were divided into quartiles to determine the risk of neurological deterioration among quartiles. | The reduction of BP in patients with acute ICH is safe. An aggressive decrease in BP might reduce the risk of neurological deterioration in the first 24 h of admission. |
| Anderson et al., 2010 [79] | Prospective randomized trial (INTERACT) | 404 | To determine the effects of intensive BP reduction on hematoma and perihematomal edema over 72 h. | The early intensive BP-lowering treatment attenuated hematoma growth over 72 h. There was no appreciable effect on perihematomal edema. |
| Qureshi et al., 2010 [80] | Prospective (ATACH) |
774 | Lobar hemorrhages. | Reduced mortality rate with systolic BP-lowering treatment. |
| Anderson et al., 2013 [81] | Prospective randomized trial (INTERACT-2) |
2839 | Deep location of hematoma (83.5%), intraventricular extension of hemorrhage (28.3%). | Death or severe disability was not reduced with intensive BP-lowering treatment. Lower modified Rankin scale with intensive BP-lowering treatment. |
| Butcher et al., 2013 [82] | Prospective randomized trial (ICH ADAPT) |
75 | Basal ganglia (74.5%), lobar (22.5%), brainstem (3.0%), intraventricular extension (38.5%). | Acute BP lowering did not worsen cerebral ischemia. |
| Sakamoto et al., 2013 [83] | Prospective, observational (SAMURAI) |
211 | Putamen (57%), thalamus (36%), lobar (7%). | Aggressive BP lowering may ameliorate clinical outcomes. |
| Rodriguez-Luna et al., 2013 [84] | Prospective | 117 | Supratentorial, intraventricular extension of hemorrhage (47%). | Systolic BP and variability predict hematoma growth and early neurological deterioration. |
| Krishnan et al., 2016 [85] | Prospective randomized trial (ENOS subanalysis) | 246 | To continue or stop antihypertensive treatment during the acute phase of ICH. | Among patients with acute ICH, immediate continuation of antihypertensive drugs during the first week did not reduce death or major disability in comparison to stopping treatment temporarily. |
| Qureshi et al., 2016 [86] | Prospective randomized trial (ATACH-2) |
1000 | Thalamus (37.8%), basal ganglia (51.2%), cerebral lobe (11.0%), cerebellum (0.1%) | A target BP values from 110 to 139 mmHg did not result in a lower rate of death or disability than a standard reduction. |
| Bozzano et al., 2017 [87] | Randomized, controlled, multicenter trial | 1000 | To determine the efficacy and safety of early and rapid BP lowering in patients with spontaneous ICH. | No clinical benefits from intensive and rapid lowering of BP. |
| Hatcher et al., 2017 [88] | Retrospective observational |
243 | Intraventricular extension of hemorrhage (64%), infratentorial bleeding (20%). | Elevated pre-hospital systolic BP (≥140 mmHg) was associated with larger hematoma volumes. |
| Rodriguez-Luna et al., 2018 [89] | Retrospective | 219 | Lobar hemorrhages (40.6%). Intraventricular extension (48.9%), subarachnoid extension (35.2%). | Pre-hospital BP was correlated with hematoma volume at admission. |
| Zhu et al., 2020 [90] | Single-center retrospective study | 166 | To compare early versus late initiation of oral antihypertensives on intensive care unit length of stay and cost of hospitalization in patients with ICH. | Early initiation of oral antihypertensives is safe and may have significant clinical and socio-economic impacts on patients with hypertensive ICH. |
ATACH: Antihypertensive Treatment of Acute Cerebral Hemorrhage; BP: blood pressure; ICH: intracerebral hemorrhage; ICH ADAPT: Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial; ENOS: Efficacy of Nitric Oxide in Stroke; INTERACT: Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial; INTERACT-2: Second Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial; SAMURAI: Stroke Acute Management with Urgent Risk-Factor Assessment and Improvement- Intracerebral Hemorrhage Study.