Rinsho Shinkeigaku (Clinical Neurology)

Symposium 2

Medical therapy for intracranial hemorrhage: Update Blood pressure management for prevention and acute treatment

Masatoshi Koga1) and Kazunori Toyoda2)

1)Division of Stroke Cave Unit, National Cerebral and Cardiovascular Center
2)Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center

Intracerebral hemorrhage (ICH) is a common stroke subtype in Japan. Hypertension is the leading cause. Perindopril Protection Against Recurrent Stroke Study (PROGRESS) revealed that blood pressure (BP) lowering could reduce stroke recurrence by 28% (ICH recurrence by 49%). The guideline for the management of hypertension (JSH2009) recommends BP control of ≤140/90 mmHg for patients with prior stroke. BP is frequently elevated in acute ICH, although BP management strategy is controversial. The guideline from the American Stroke Association suggests if systolic BP (SBP) >180 mmHg and there is no evidence of elevated intracranial pressure, then consider a modest reduction of BP. A nationwide survey revealed that SBP lowering to ≤160 mmHg using intravenous nicardipine in acute ICH is a major strategy in Japan, and the safety was confirmed by a multicenter, prospective, observational study. Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT) and Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) showed the feasibility and safety of early rapid BP lowering to 140 mmHg. INTERACT2 and ATACH II are the randomized trials to compare the guideline-based control (<180 mmHg) and strict control (<140 mmHg). We have just started to enroll patients to ATACH II from Japan on February 2012.
Full Text of this Article in Japanese PDF (205K)

(CLINICA NEUROL, 52: 1110|1112, 2012)
key words: intracerebral hemorrhage, hypertension, prevention, blood pressure lowering, nicardipine

(Received: 24-May-12)