Controlling blood pressure soon after intracerebral hemorrhage: The SAMURAI-ICH Study and its successors

The impact of acute therapy for intracerebral hemorrhage (ICH) lags far behind that for acute ischemic stroke. Intensive blood pressure lowering is a promising therapeutic strategy for acute ICH, especially for East Asian patients whose etiological mechanism is more commonly hypertension than that o...

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Bibliographic Details
Published in:Hypertension research 2022-04, Vol.45 (4), p.583-590
Main Authors: Toyoda, Kazunori, Koga, Masatoshi
Format: Article
Language:English
Subjects:
Antihypertensive Agents - pharmacology
Antihypertensive Agents - therapeutic use
Blood pressure
Blood Pressure - physiology
Cerebral Hemorrhage - drug therapy
Drug therapy
Hemorrhage
Humans
Hypertension
Ischemic Stroke
Multicenter Studies as Topic
Observational Studies as Topic
Pilot Projects
Prospective Studies
Randomized Controlled Trials as Topic
Review
Stroke
Treatment Outcome
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Summary:The impact of acute therapy for intracerebral hemorrhage (ICH) lags far behind that for acute ischemic stroke. Intensive blood pressure lowering is a promising therapeutic strategy for acute ICH, especially for East Asian patients whose etiological mechanism is more commonly hypertension than that of patients in the Western population. A multicenter, prospective, observational study named the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-IntraCerebral Hemorrhage (SAMURAI-ICH) study, involving 211 patients from ten Japanese stroke centers, was performed to elucidate the safety and feasibility of blood pressure lowering to 160 mmHg or less in acute ICH patients using intravenous nicardipine. When we started the study, intravenous nicardipine was not officially approved for hyperacute ICH patients in Japan. The SAMURAI-ICH study was also a pilot study to judge the feasibility of participation by many Japanese investigators in an international, randomized, controlled trial named the Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH)-2 trial. The SAMURAI-ICH study, ATACH-2 trial, and their combined individual participant data meta-analysis produced several new interesting findings on how to control blood pressure levels in acute ICH patients. Some of the findings are introduced in the present review article.
ISSN:0916-9636
1348-4214
DOI:10.1038/s41440-022-00866-8