Effect of hyperacute intensive antihypertensive treatment on the prognosis of intracerebral hemorrhage in basal ganglia region / 中国脑血管病杂志

ABSTRACT

Objective To investigate the effect of hyperacute intensive antihypertensive treatment on the prognosis of intracerebral hemorrhage in basal ganglia region. Methods From January 2013 to December 2015,100 patients with intracerebral hematoma in basal ganglia region (onset ≤3 h)at the Neurological Intensive Care Unit,the First Affiliated Hospital of Dalian Medical University were enrolled prospectively. They all randomly received the intensive antihypertensive or standard antihypertensive treatment voluntarily. They were divided into either an intensive antihypertensive group or a standard antihypertensive group according to the random number table (n = 50 in each group). Within 1 h after beginning to treatment,the target systolic blood pressure was controlled in 130 -140 mmHg in the intensive antihypertensive group,the target systolic blood pressure was controlled in 160 -180 mmHg in the standard antihypertensive group,and the target systolic blood pressure was maintained respectively in the following 7 d. Head CT was performed gain at 24 h after treatment. The intracranial hematoma expansion was evaluated. The National Institutes of Health Stroke Scale (NIHSS)and the modified Rankin scale (mRS)were used to evaluate their prognoses. The differences of the cumulative mortality in both groups were compared at the same time. Results The incidences of hematoma expansion of the intensive antihypertensive group and the standard antihypertensive group were 12. 0% (6/ 50)and 30. 0% (15/ 50)respectively. There was significant difference between the 2 groups (χ2 = 4. 882,P = 0. 027). There were no significant differences in NIHSS scores within or between both groups at each time points (all P > 0. 05). They were followed up for 90 d,no adverse events occurred in both groups. The favorable prognosis rates of the neurological function were 36. 0% (18 / 50)and 18. 0% (9 / 50)respectively in the intensive antihypertensive group and the standard antihypertensive group. There was significant difference between the 2 groups (χ2 = 0. 411,P =0. 043). Kaplan-Meier curves showed that the cumulative mortality at 24 h,within 7 d and 90 d in the intensive antihypertensive group and the standard antihypertensive group were 4. 0% (2 / 50),6. 0%(3 / 50),and 10. 0% (5 / 50),respectively,those of the standard antihypertensive group were 10. 0%(5 / 50),24. 0%(12 / 50),and 30. 0%(15 / 50),respectively. The results of Log-rank test found that there was significant difference in cumulative mortality between the 2 groups (χ2 =6.280,P =0.012). Conclusions The intensive antihypertensive treatment in the hyperacute cerebral hemorrhage is safe and feasible in basal ganglia region. It contributes to improve prognosis of neurological function,and reduce the incidence of hematoma expansion and the 90 d cumulative mortality.