Improving Acute Blood Pressure Control in Intracerebral Hemorrhage: A Prospective Clinical Audit at EDGH
DOI:
https://doi.org/10.22317/imj.v9i3.1332Keywords:
Cerebral Hemorrhage, Blood Pressure, Guideline, Stroke, Clinical AuditAbstract
Objectives: The prospective audit aims to evaluate how blood pressure is managed in patients with acute ICH against NICE NG128 standards, alongside exploring staff awareness and barriers to compliance.
Methods: This prospective audit included 39 patients with CT-confirmed ICH who presented between February and May 2021. Data were collected retrospectively from electronic records. A structured questionnaire was distributed to multidisciplinary staff involved in ICH care to assess guideline awareness and implementation challenges.
Results: Out of 34 patients eligible for rapid BP lowering, only 9 (26%) received antihypertensive treatment within one hour. Neurosurgical referrals were made for all patients, but only one was accepted. Staff survey (n=40) revealed that 47.5% were unaware of the correct NICE target for BP, and only 25% knew the appropriate BP monitoring duration. Moreover, 77% of staff reported difficulty-achieving target BP in clinical practice.
Conclusion: There is suboptimal adherence to NICE guidance for BP management in acute ICH at EDGH, compounded by low staff awareness and inconsistent practices. Targeted education, a standardized BP-lowering protocol, and re-auditing following implementation are recommended to improve care quality and patient outcomes.
References
Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C, et al. Rapid blood pressure lowering in patients with acute intracerebral haemorrhage. N Engl J Med. 2013;368(25):2355–2365.
Arima H, Tzourio C, Anderson C. Blood pressure lowering in patients with acute stroke. Lancet Neurol. 2015;14(6):577–584.
Delcourt C, Sato S, Zhang S, Sandset EC, Zheng D, Chen X, et al. Intracerebral haemorrhage outcomes: severity and location. J Neurol Neurosurg Psychiatry. 2016;87(6):660–665.
National Institute for Health and Care Excellence (NICE). Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NICE guideline NG128. London: NICE; 2019.
National Institute for Health and Care Excellence (NICE). Acute intracerebral haemorrhage management: update to NG128. London: NICE; 2022.
Qureshi AI, Palesch YY, Martin R, Novitzky M, Cruz-Flores S, Ehtisham A, et al.; ATACH-2 Investigators. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med. 2016;375(11):1033–1043.
Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF. Spontaneous intracerebral hemorrhage. N Engl J Med. 2001;344(19):1450–1460.
van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010;9(2):167–176.
Qureshi AI, Palesch YY, Martin R, Novitzky M, Cruz-Flores S, Ehtisham A, et al.; ATACH-2 Investigators. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med. 2016;375(11):1033–1043.
Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF. Spontaneous intracerebral hemorrhage. N Engl J Med. 2001;344(19):1450–1460.
Sakamoto Y, Koga M, Toyoda K, et al. Systolic blood pressure variability and neurological deterioration in acute intracerebral haemorrhage. Stroke. 2013;44(11):3146–3151.
Steiner T, Salman RAS, Beer R, et al. European Stroke Organisation guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke. 2014;9(7):840–855.
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