【摘 要】
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Background and Purpose: Intracerebral hemorrhage (ICH) causes 10-15% of all first-ever strokes with a 35-52% 30-day mortality.Blood pressure (BP) reduction may attenuate hematoma growth.The ACCELERATE
【机 构】
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The Ohio State University USA
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Background and Purpose: Intracerebral hemorrhage (ICH) causes 10-15% of all first-ever strokes with a 35-52% 30-day mortality.Blood pressure (BP) reduction may attenuate hematoma growth.The ACCELERATE trial evaluated the efficacy and safety of intravenous clevidipine infusion for the rapid treatment of acute hypertension in ICH patients.Methods: ICH patients presenting within 12 hours of symptoms and systolic blood pressure (SBP)> 160 mm Hg were prospectively enrolled, and treated with open-label intravenous clevidipine, started at 2.0 mg/h and titrated every 90 seconds until BP< 160 mm Hg was achieved then titrated to keep target SBP between 140 to 160 mm Hg.Results: Thirty-five patients (mean age 64 years; 27 males) with baseline median Glasgow Coma Scale score 12, median NIH Stroke Scale score 14, and mean SBP 186 mm Hg received clevidipine.Mean time from symptom onset to infusion start was 5.5 hours.Median time to achieve SBP target range was 5.5 minutes.All patients achieved target SBP within 30 minutes; 96.9% achieved target SBP without receiving additional or alternative intravenous antihypertensives.Mean average clevidipine infusion rate for the first 30 minutes of treatment was 7.9 mg/h.CT scans showed minimal hematoma volume change for the overall population (median change-0.01 mL;-2.9%).Mild/moderate hypotension was reported in 3 patients and resolved with dose reduction or drug discontinuation.Conclusion: 1CH patients overall showed minimal ICH volume change after SBP reduction with clevidipine.Clevidipine was effective and safe for rapid BP reduction in this cohort of critically ill patients.
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