Abstract NS4: Early and Continued Nursing Care Allows a Fast, Intensive, and Maintained BP Reduction in Patients With Acute Intracerebral Hemorrhage

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Background and Purpose: Recent studies have highlighted the key influence of both time to achieve blood pressure (BP) control and the persistence of BP stable in the potential benefit of intensive BP reduction on attenuating intracerebral hemorrhage (ICH) expansion. We aimed to compare two different BP management protocols in acute ICH to determine the influence of stroke nursing practice in BP control over first 24h. Methods: Consecutive patients with spontaneous ICH <6h and systolic BP (SBP) >150 mmHg under an early (antihypertensive IV bolus by nursing attention at CT scan), intensive (SBP target <140 mmHg), and maintained (antihypertensive continuous infusion after IV bolus) BP protocol within a 4-year period (2013-2017) were evaluated (Early-Intensive-Maintained SBP group). They were compared with a 1:1 matched prospectively collected historical control group (2009-2013) under a non-early (IV bolus by nursing attention at Stroke Unit), non-intensive (SBP target <180 mmHg), and no-maintained (no continuous infusion after initial IV bolus) BP protocol. All patients underwent a bedside non-invasive BP monitoring at 15 min intervals over the first 24h. The time from BP lowering treatment initiation to achieve SBP target and the persistence of SBP bellow target at different time points was recorded in both groups. Results: One hundred and three Early-Intensive-Maintained SBP patients were matched with 103 controls. Mean age was 71.7±13.3 years, 134 (65%) were men, and median SBP was 177 (162-197) mmHg. Median time to SBP target achievement was lower in Early-Intensive-Maintained SBP patients as compared with control group (45 [30-60] vs. 90 [27-167.50] min, P=0.045 ). Early-Intensive-Maintained SBP patients maintained the SBP below the target more frequently than control group at different time points, including 60 min (40.8% vs. 36.9%, P <0.001), 120 min (36.9% vs. 34%, P <0.001), 18h (32% vs. 22.3%, P <0.001), and 24h (33% vs. 4.9%, P <0.001), respectively. Conclusions: The stroke nurse plays a key role in the management of BP in acute ICH patients. An early and continued nursing care allows a fast and maintained BP reduction in acute ICH patients under an intensive BP reduction protocol.

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