Is emergent anti-hypertensive treatment beneficial in intracranial hemorrhage?

A retrospective chart review of adult patients with primary intracranial hemorrhage (ICH) was conducted to determine the effects of emergent anti-hypertensives on mortality. Data included mean arterial pressure (MAP), Glascow Coma Scale score (GCS), ICH size, and anti-hypertensive treatment. Multi-variable logistic regression determined the effect of anti-hypertensives on ICH mortality. Of 66 patients studied, the overall mortality was 30.3%. Mortality was 34.5% for patients initially treated with anti-hypertensives vs. 25.8% for patients not treated. After controlling for age, MAP, GCS, and ICH size, anti-hypertensives given within the first 6 h of presentation were associated with a reduction in mortality with a p value of 0.0375 and an odds ratio of 140 (95% confidence interval [CI] 1.332 to >999). However, this effect may not occur in patients presenting with a systolic blood pressure (SBP) < 200 mm Hg. In conclusion, in patients with primary intracranial hemorrhage, there was a significant decrease in mortality associated with emergent anti-hypertensive therapy. A larger prospective study is needed to confirm these findings, define the subgroups that may benefit, and better determine the effect size.