Abstract WP21: Staged Implementation Of A Rapid, Intensive And Sustained Blood Pressure Protocol In Patients With Acute Intracerebral Hemorrhage

Background and Purpose: The potential benefit of blood pressure (BP) lowering in intracerebral hemorrhage (ICH) patients is time-dependent and is an easy and modifiable treatment applicable to different hospital scenarios. However, previous clinical trials did not establish consensus about the best BP strategy to achieve a rapid and sustained BP control. We aimed to assess the impact of learning a staged implementation of rapid-intensive-sustained BP protocol on time targets and BP control rate over the first 24 hours of ICH. Methods: We conducted a retrospective analysis of data prospectively collected of consecutive patients with spontaneous ICH (<6h) and systolic BP (SBP) >150 mmHg under a rapid (antihypertensive IV bolus by a stroke nurse at CT scan), intensive (SBP target <140 mmHg within 1 hour after BP agent onset),and sustained (antihypertensive continuous infusion immediately after IV bolus) 24-hour BP protocol during a 6-year period. BP was recorded regularly according to the following schedule: every 15 minutes (0-6 hours); every 30 minutes (6h to 12h), and every 60 minutes (12h to 24h). We recorded the time from BP treatment onset to SBP target achievement and the rate of SBP sustention below target (<140 mm Hg) at all time frames. The protocol implementation was divided in 6 consecutive year periods. Results: A total of 207 patients were included in the study. Compared between the periods, the frequency of SBP target achievement during the first hour was increased steadily over different periods(33.3% vs. 54.5% vs. 69.2% vs 69.4% vs 75% and 59.7%; P=0.024 ); median time to SBP target achievement tended to be lower during the evolution of protocol assessment (120 [45-240] min; 49.5 [30-101] min; 53 [29-82] min; 47 [28-74] min; 48 [27-66] min; 50 [30-85] min; P=0.054 ) and SBP sustention rate below the target improve during the acute phase at different time frames, including 2h (26.3% vs. 71.9% vs 60% vs 73.9% vs. 57,7% vs 59.5%; P= 0.012 ), 4h (57.1% vs. 63.3% vs 87.5% vs 85% vs. 61.5% vs. 69.2%; P= 0.05 ), 6h (60.9% vs. 58.6%, vs 95.5% vs 84.4% vs 58.3% vs. 75%; P=0.009 ). Conclusions: Rapid-intensive-sustained BP protocol is a good intervention to both achieve a rapid BP target and reduce time delays,and improve the rates of BP control over the acute phase of ICH patients.