Government and Regulations

Standard vs Intensive Emergency Stroke Treatment

Study results find little to no difference in blood pressure levels based on severity of stroke treatment.


 

Standard and intensive blood pressure treatments are equally effective in emergency treatment of acute intracerebral hemorrhage, according to a study funded by the National Institute of Neurological Disorders and Stroke. That is, reducing systolic blood pressure rapidly to 140-179 mm Hg worked as well as reducing to 110-139 mm Hg.

“For decades, doctors wondered whether intensive blood pressure management was more effective than standard treatment for controlling intracerebral hemorrhage,” said principal investigator Adnan Qureshi, MD, professor of neurology, neurosurgery and radiology at the Zeenat Qureshi Stroke Research Center, University of Minnesota in Minneapolis. “Our results may help patients and their doctors make better treatment decisions.”

In the 110-site international study, 1,000 patients were treated within 4.5 hours of a stroke. Half were assigned to intensive treatment and half to standard treatment. Brain scans taken 24 hours after treatment showed no difference in the rates of hemorrhage growth between the 2 groups. Because the researchers found no differences, the study was stopped after enrolling 1,000 patients rather than 1,280.

Moreover, after 90 days, the rate of death or severe disability was about 38% in both groups—a number much lower than the expected 60%. Patients in the intensive treatment group had a slightly higher rate of serious adverse events in the 90 days after the stroke but at lower levels than expected. The researchers say that may be because more than half of enrolled patients had experienced mild strokes and had a better chance of good results.

Their findings suggest that intensive reduction in the systolic blood pressure level does not provide “an incremental clinical benefit,” the researchers say. Dr. Qureshi noted, “Rapidly lowering blood pressure to normal levels may further damage the brain. The levels we used are tolerable for emergencies. Normal levels can be safely obtained gradually.”

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