54 Acute Blood Pressure Lowering in Spontaneous Acute Intra-cerebral Haemorrhage: A Re-audit in a Tertiary Referral Stroke Centre (Age and Ageing)

AbstractBackgroundAcute blood pressure (BP) lowering to a target of <150mmHg systolic improves outcomes in patients with acute spontaneous intra-cerebral haemorrhage (sICH). It is thought that the beneficial effect of BP-lowering in sICH is time-sensitive and mediated through the prevention of haematoma expansion. The American Heart Association guidelines state that BP lowering to <150 mmHg or lower is safe and can improve functional outcome. Our aim was to re-evaluate the performance of clinicians in meeting target SBP levels of <150mmHg in patients with acute sICH within 1 hour of presentation, following the introduction of a BP-lowering protocol in our centre.MethodsWe undertook a retrospective chart review of consecutive patients with an acute sICH admitted to our centre between September 2017 and May 2018. Any patient who did not receive active medical management from the outset of presentation due to immediate initiation of palliative measures were excluded. The time from presentation to target BP and BP measured at 1 hour were recorded. Any protocol violations were also documentedResults11 patients were included (mean age 77.5years, 55% female). The mean BP at presentation and 1 hour was 186/93mmHg and 161/93mmHg respectively. The median and mean times from presentation to first achieved target BP was 129 and 120minutes respectively. At least 1 protocol violation occurred in 66.6% of cases. The most common protocol violation was the failure to escalate to an intravenous infusion of a BP-lowering agent in a timely manner when bolus therapy had failed.ConclusionAn introduction of a BP protocol for patients with an acute sICH did not improve performance on achieving rapid SBP-lowering to target levels of <150mmHg. Strategies to improve awareness of this protocol are required to improve adherence and its successful implementation.