HIỆU QUẢ VÀ AN TOÀN CỦA VIỆC KIỂM SOÁT HUYẾT ÁP SỚM TÍCH CỰC Ở BỆNH NHÂN ĐỘT QUỴ CHẢY MÁU NÃO CẤP TẠI KHOA ĐỘT QUỴ BỆNH VIỆN 103

Abstract

Objective: To evaluate the safety and beneficial effect of rapid lowering of blood pressure in patients with acute intracerebral hemorrhage.

Methods: We randomly assigned 73 patients who had had an acute intracerebral hemorrhage within the previous 6 hours and who had elevated systolic blood pressure to receive intensive treatment to lower their blood pressure (with a target systolic level of <140mmHg within 1 hour) or guideline-recommended treatment (with a target systolic level of <180mm Hg). The primary outcome was death or major disability, which was defined as a score of 3 to 6 on the modified Rankin scale (mRs) (in which a score of 0 indicates no symptoms, a score of 5 indicates severe disability, and a score of 6 indicates death) at 90 days. The rate of serious adverse events was compared between the two groups.

Results: Among the 73 patients for whom the primary outcome could be determined, 35 patients (48.0%) receiving intensive treatment, as compared with 38 (52%) receiving guideline-recommended treatment. The ordinal analysis showed significantly lower mRs with intensive treatment (p<0.05). Mortality was 2.9% in the group receiving intensive treatment and 2.6% in the group receiving guideline-recommended treatment. Nonfatal serious adverse events occurred in 2.9% and 2.6% of the patients in the two groups, respectively.

Conclusion: In patients with intracerebral hemorrhage, intensive lowering of blood pressure did not result in a significant reduction in the rate of the primary outcome of death or severe disability. An ordinal analysis of mRs indicated improved functional outcomes with intensive lowering of blood pressure.