Deans' stroke musings: Acute Blood Pressure Lowering and Risk of Ischemic Lesions on MRI After Intracerebral Hemorrhage

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, April 23, 2025

Acute Blood Pressure Lowering and Risk of Ischemic Lesions on MRI After Intracerebral Hemorrhage

Because our incompetent stroke medical 'professionals' still haven't figured out an EXACT BLOOD PRESSURE MANAGEMENT PROTOCOL post stroke! And YOU bear the failure of that! Hope your competent? doctor guesses correctly because the poor outcome happens to you! Your doctor gets off scot-free and still gets paid! Pay for performance would solve that problem pretty fast.

For stroke this is incredibly simple. Once the bleed is stopped or the clot removed any additional neurons that die, the hospital pays the patient $1000 a dead neuron and the doctors don't get paid at all. If the patient doesn't get 100% recovered the doctors and therapists don't get paid. Pay for performance will work! Painful at first but survivors don't care about your financial pain since you didn't care about their recovery since you got out of medical school.

Acute Blood Pressure Lowering and Risk of Ischemic Lesions on MRI After Intracerebral Hemorrhage

Key Points

Question Does acute blood pressure (BP) reduction increase the incidence of subacute ischemic lesions in spontaneous intracerebral hemorrhage (ICH)?

Findings The frequency of ischemic lesions detected with diffusion-weighted magnetic resonance imaging at 48 hours did not increase in patients with ICH randomized to an intensive systolic BP target of less than 140 mm Hg within 6 hours of onset, compared with those with a target of less than 180 mm Hg.

Meaning Study findings support the safety of systolic BP reduction to a target of less than 140 mm Hg in patients with acute ICH.

Abstract

Importance Diffusion-weighted imaging (DWI) lesions have been demonstrated in patients with subacute intracerebral hemorrhage (ICH), suggesting ischemic injury, which may be related to blood pressure (BP) reduction.

Objective To test the hypothesis that acute intensive BP lowering is associated with DWI lesions after ICH.

Design, Setting, and Participants The Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial 2 (ICHADAPT-2) was a multicenter, randomized, open-label, blinded–end point trial. Between November 2012 and August 2022, patients with ICH presenting within 6 hours of onset were randomized to a systolic BP (SBP) target of less than 140 mm Hg or less than 180 mm Hg. The trial was conducted at 3 comprehensive stroke centers in Canada and Australia, including 1 telestroke referral hub and 1 community stroke hospital. A total of 162 patients with acute ICH were randomized. The primary analysis population was restricted to those undergoing DWI at 48 hours.

Intervention Patients were randomly assigned to an acute SBP target of less than 140 mm Hg or less than 180 mm Hg.

Main Outcome and Measure The primary end point was the incidence of acute DWI lesions on brain magnetic resonance imaging obtained 48 ± 12 hours after randomization.

Results DWI was obtained in 79 (48% female) patients with a mean (SD) age of 71 (13) years and median baseline ICH volume of 11.2 (range, 0.5-122.2) mL. The median times from onset to randomization and DWI were 3.17 (range, 0.7-14.6) hours and 51.6 (range, 17.0-121.4) hours, respectively. Mean (SD) baseline SBP was 183 (22) mm Hg in the less than 140 mm Hg target group and 181 (28) mm Hg in the less than 180 mm Hg target group. Mean SBP was lower over the 48-hour period after randomization in the less than 140 mm Hg group (mean difference, 18.9 mm Hg [95% CI, 17.6-20.2]; P < .001). DWI lesions were detected in 13 of 42 patients (31%) in the less than 140 mm Hg group and 14 of 37 patients (38%) in the less than 180 mm Hg group (odds ratio, 0.74 [95% CI, 0.12-4.64]; P = .32). The median number of DWI lesions (1 [95% CI, 1-10] vs 1.5 [95% CI, 1-10]; P = .26) and total DWI lesion volume (0.1 [95% CI, 0.01-41.3] mL vs 0.3 [95% CI, 0.02-2.03] mL; P = .17) were not different in the less than 140 mm Hg and less than 180 mm Hg groups.

Conclusions and Relevance DWI lesion frequency and volume were unaffected by intensive antihypertensive therapy. These results support the safety of early BP reduction in acute ICH.

(So, YOU INCOMPETENTLY STILL DIDN'T CREATE A PROTOCOL ON THIS! Or created a protocol delivery mechanism to get the protocol to all stroke hospitals!)