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Efficacy of the American Heart Association/American Stroke Association guidelines for ultra-early, intentional antihypertensive therapy in intracerebral hemorrhage.

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Efficacy of the American Heart Association/American Stroke Association guidelines for ultra-early, intentional antihypertensive therapy in intracerebral hemorrhage.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Fujii, Mutsumi Nakagawa, Kazuhiko Tomita, Hiroki Tone, Osamu Tamaki, Masashi Takada, Yoshiaki Hokari, Mitsuhiko Nariai, Tadashi Ohno, Kikuo
Spatial Coverage	United States
Description	Country affiliation: Japan Author Affiliation: Fujii M ( Department of Neurosurgery, Tokyo Medical and Dental University, 5-45, Yushima 1-cyome, Bunkyo-ku, Tokyo 113 8510, Japan. mutsu-ygc@umin.ac.jp)
Abstract	Whether the intentional antihypertensive therapy recommended by the American Heart Association/American Stroke Association (AHA/ASA) guidelines has clinical benefit for patients who have acute spontaneous intracerebral hemorrhage (ICH) has yet to be proven. We retrospectively reviewed the clinical charts of 175 patients with putaminal or thalamic ICH with acute hypertension to examine the correlation between the efficacy of antihypertensive therapy within 3 hours of onset, hematoma expansion (HE) after hospitalization and clinical outcome. The aim of the antihypertensive therapy was to achieve and maintain a systolic blood pressure of 120 mm Hg to 160 mm Hg until the second CT scan. The mean arterial pressure (MAP) after admission was the average MAP values measured every hour for the first 3 hours of hospitalization or until the second CT scan, if this was performed within the same timeframe. Thirty-two (18.3%) patients were found to have HE. Prior to the second CT scan, antihypertensive medications were administered to all patients without any major complications. A multiple logistic regression analysis revealed that a MAP of >110 mm Hg after admission was the only variable independently associated with HE (odds ratio [OR] = 3.455; 95% confidence interval [CI] = 1.510-8.412; p = 0.004). Modified Rankin Scale scores of < or = 3 on day 30 were significantly more common in those patients without HE (p = 0.002). Our findings suggest that there are clinical benefits, by the prevention of subsequent HE, in maintaining a MAP level lower than that recommended by the AHA/ASA (110 mm Hg) after hospitalization for patients who have ICH.
File Format	HTM / HTML
ISSN	09675868
Issue Number	9
Volume Number	17
e-ISSN	15322653
Journal	Journal of Clinical Neuroscience
Language	English
Publisher	Elsevier
Publisher Date	2010-09-01
Publisher Place	Great Britain (UK)
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Medicine American Heart Association Antihypertensive Agents Administration & Dosage Cerebral Hemorrhage Drug Therapy Intention Practice Guidelines As Topic Standards Adult Aged Aged, 80 And Over Etiology Female Hematoma Prevention & Control Humans Hypertension Complications Male Middle Aged Retrospective Studies Time Factors Treatment Outcome United States Comparative Study Journal Article
Content Type	Text
Resource Type	Article
Subject	Neurology Physiology (medical) Neurology (clinical) Surgery

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