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

Ken S Butcher1, Brian Buck2, Dar Dowlatshahi3,4

  • 1School of Clinical Medicine, University of New South Wales, Sydney, Australia.

JAMA Neurology
|April 21, 2025
PubMed
Abstract

Insights

Intensive blood pressure lowering in acute intracerebral hemorrhage (ICH) did not increase diffusion-weighted imaging (DWI) lesions. This suggests that early blood pressure reduction is safe for patients with acute ICH.

Area of Science:

  • Neurology
  • Radiology
  • Cardiovascular Medicine

Background:

  • Diffusion-weighted imaging (DWI) lesions in subacute intracerebral hemorrhage (ICH) suggest ischemic injury, potentially linked to blood pressure (BP) reduction.
  • The relationship between acute intensive BP lowering and DWI lesions post-ICH requires investigation.

Purpose of the Study:

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

Main Methods:

  • The Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial 2 (ICHADAPT-2) was a multicenter, randomized trial involving 162 patients with acute ICH.
  • Patients were randomized to a systolic BP (SBP) target of <140 mm Hg or <180 mm Hg within 6 hours of onset.
  • The primary endpoint was the incidence of acute DWI lesions on MRI at 48 ± 12 hours post-randomization.

Main Results:

  • DWI was performed in 79 patients (48% female, mean age 71 years).
  • No significant difference in DWI lesion frequency (31% vs 38%), number, or volume was observed between the <140 mm Hg and <180 mm Hg target groups.
  • Mean SBP was significantly lower in the <140 mm Hg group over 48 hours (mean difference 18.9 mm Hg).

Conclusions:

  • Intensive antihypertensive therapy did not affect DWI lesion frequency or volume in acute ICH.
  • These findings support the safety of early BP reduction in acute ICH management.

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