Title: Intensive BP Control in Spontaneous Intracranial Hemorrhage
题目：自发性颅内出血时要强化血压控制
Author 作者: John Greenwood
Managing the patient with hypertensive emergency in the setting of spontaneous intracerebral hemorrhage (ICH) is often a challenge. Current guidelines from the American Stroke Association are to target an SBP of between 160 - 180 mm Hg with continuous or intermittent IV antihypertensives. Continuous infusions are recommended for patients with an initial SBP > 200 mm Hg.

处理高血压危象导致的自发性脑出血（ICH ）患者往往是一个挑战。美国脑卒中协会目前的指南是通过持续或间歇静脉降压药将收缩压控制在160 – 180 mmHg。患者初始收缩压> 200 mmHg要持续输注。
An emerging concept is that rapid and aggressive BP control (target SBP of 140) may reduce hematoma formation, secondary edema, & improve outcomes.

一个新理念是快速和积极的血压控制（目标收缩压140）可减少血肿形成，继发性水肿，及改善预后。
Recently published, the INTERACT 2 trial (n=2,829) compared intensive BP control (target SBP < 140 within 1 hour) to standard therapy (target SBP < 180) found:
最近公布的INTERACT2试验（n = 2,829）将强化血压控制（1小时内收缩压目标<140）和标准治疗（目标收缩压< 180 ）进行了比较，发现：
• No difference in mortality (11.9% vs 12%, respectively)
• 死亡率无明显差异（分别为11.9 ％和12 ％ ）
• Improved functional status (secondary outcome) with intensive BP control
• 强化血压控制改善了功能状态（次要结果）
• Intensive lowering of BP in patients with acute ICH appears safe
• 积极降血压对急性脑出血病人是安全的

A Post-hoc analysis of the INTERACT 2 published just this month suggests that large fluctuations in SBP (>14 mmHg) during the first 24 hours may increase risk of death & major disability at 90 days.
一个本月发表的INTERACT2析因分析表明，在第一个24小时内的收缩压大幅度波动（ > 14 mmHg），可能会增加90天时死亡率和主要伤残率的风险。

Bottom Line: INTERACT 2 was a large RCT but not a great study (keep on the look out for ATACH II). However, in patients with spontaneous ICH, consider early initiation of an antihypertensive drip (preferably nicardipine) in the ED to reduce blood pressure fluctuations early with a target SBP of 140 mmHg.
要点： INTERACT2是一个大型的随机对照试验，但并不是没有瑕疵的（可关注ATACH II）。无论如何， 对自发性脑出血患者，可考虑在急诊科尽快静脉使用降压药（最好尼卡地平），以减少血压波动并将收缩压控制在140 mmHg。
References参考文献：

1. Morgenstern LB, Hemphill JC, Anderson C, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2010;41(9):2108-29.
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