Recently, Professor Yang Hong's team from the Department of Intensive Care Medicine at the Third Affiliated Hospital of Southern Medical University, along with collaborators, provided the first confirmation that a blood pressure lowering regimen based on analgesia and sympathetic inhibition aids in early blood pressure control for patients with spontaneous intracerebral hemorrhage (ICH), revolutionizing traditional concepts of antihypertensive therapy. The relevant findings were published online in Anesthesiology.
ICH carries high mortality and disability rates, imposing significant medical and economic burdens on society. Adverse outcomes in ICH patients are closely related to post-onset hypertension and excessive blood pressure variability. However, there is currently no recommended optimal antihypertensive medication. Previous studies have indicated that remifentanil, through its potent and rapid analgesic effect combined with dexmedetomidine's sympathetic inhibitory action, may control elevated blood pressure. Therefore, employing a strategy of remifentanil combined with dexmedetomidine for blood pressure reduction may be a rational therapeutic approach, but its effectiveness and safety in ICH patients have not been validated.
In this original clinical study, 338 acute ICH patients with systolic blood pressure (SBP) ≥150 mmHg from 14 intensive care units in China were randomly assigned to the experimental group (standard guideline-based antihypertensive therapy using remifentanil and dexmedetomidine) or the control group (standard guideline-based antihypertensive therapy alone) to receive early intensified antihypertensive treatment. At the initiation of treatment at 1 hour, the SBP achievement rate (SBP <140 mmHg considered achieved) in the experimental group was significantly higher than that in the control group (101/161, 62.7% vs. 66/166, 39.8%, difference 23.2%, 95% CI, 12.4 to 34.1%, P < 0.001).
Furthermore, patients in the experimental group experienced effective mild sedation during intervention therapy while also reducing the incidence of agitation. In terms of safety, the overall rates of adverse events and severe adverse events were similar between the two groups, but the incidence of bradycardia and respiratory depression was slightly higher in the experimental group.
This randomized controlled trial convincingly demonstrates that for ICH patients with SBP ≥150 mmHg, applying a blood pressure lowering regimen based on remifentanil and dexmedetomidine significantly improves the SBP control rate at 1 hour of treatment, enabling rapid and stable reduction of elevated blood pressure in ICH patients, thus providing a novel and promising option for early intensified antihypertensive treatment in the acute phase of ICH.
This study provides innovative clinical evidence for early intensified antihypertensive treatment in ICH patients, holding significant clinical value and milestone significance.
The above research is the first nationwide multicenter clinical study initiated and led by the Third Affiliated Hospital of Southern Medical University, including participating units such as Xuanwu Hospital of Capital Medical University, Qilu Hospital of Shandong University, and the First Hospital of Lanzhou University, among others.
Link to the paper: https://doi.org/10.1097/ALN.0000000000004986
