Location of hemorrhage as predictive factor for refractoriness to blood pressure control in acute, non-lobar, hypertensive intracerebral hemorrhages

Abstract

Background. Uncontrolled hypertension in acute intracerebral hemorrhages (ICH) may cause hematoma expansion within the first 24 hours, and increase patient mortality. We investigated whether there was an association between ICH location and the difficulty in lowering BP in patients with acute hypertensive non-lobarlCH. Methods: This is a retrospective cohort study of adults diagnosed with non-lobar ICH admitted at a tertiary hospital over a 2-year period. We documented the time to attain target mean arterial pressure (MAP) of 110-130 mmHg, as well as the use of antihypertensive medications. Results: Of 357 patients admitted for non-lobar ICH, 47 patients fulfilled the study criteria. Basal ganglia hemorrhages were the most common (47%), followed by thalamic (34%), cerebellar (11%), and pontine hemorrhages (8%). While there were no significant differences in baseline MAP among the different sites of hemorrhage, those with thalamic ICH had a significantly longer time-to-target MAP (p=0.02) and required three or more classes of oral antihypertensive medications (p<0.001). Conclusions. Acute thalamic intracerebral hemorrhages may require multiple classes of antihypertensives to lower blood pressure to safer levels.