Nerses Sanossian, MD
Intracerebral hemorrhage is the most deadly stroke subtype, and in the past there has been a lot of nihilism about developing effective treatment. There is not much one can do to change the outcome of patients with ICH once the final hematoma volume is established, so much of the focus is on preventing expansion through lowering blood pressure and promoting thrombosis. Aggressive lowering of BP in stroke has always been haunted by the fear of reducing cerebral blood flow and exacerbating brain injury. The ICH ADAPT investigators wanted to study the effect of meaningful BP reduction on peri-hematomal cerebral blood flow.
The ICH ADAPT investigators report that there is no change in CBF in the peri-hematomal region as measured by CT perfusion when BP is reduced by an average of 27 mm Hg over two hours. This was a substantial reduction on BP over a relatively short period of time during the acute phase of ICH.
ICH ADAPT has provided further evidence that early and aggressive blood pressure reduction in ICH is safe. We are eagerly awaiting the results of the definitive studies of BP reduction for ICH, such as the second (main phase) of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial or INTERACT2 to see if this approach is effective.