• Cheryl Carcel, Shoichiro Sato, Danni Zheng, Emma Heeley, Hisatomi Arima, Jie Yang, Guojun Wu, Guofang Chen, Shihong Zhang, Candice Delcourt, Pablo Lavados, Thompson Robinson, Richard I Lindley, Xia Wang, John Chalmers, Craig S Anderson, and Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 Investigators.
• 1Neurological and Mental Health Division, The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia. 2Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. 3Department of Neurology, Hebei Yutian Hospital, Tangshan, China. 4Department of Neurology, Xuzhou Central Hospital, Xuzhou, China. 5Department of Neurology, West China Hospital, Sichuan University, Chengdu, China. 6Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile. 7Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, United Kingdom.
• Crit. Care Med. 2016 Jul 1; 44 (7): 1388-94.

ObjectivesTo determine the association of hyponatremia at presentation with clinical and imaging outcomes in patients with acute intracerebral hemorrhage.DesignRetrospective pooled analysis of prospectively collected data from 3,243 participants of the pilot and main phases of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials 1 and 2 (international, multicenter, open, blinded endpoint, randomized controlled trials designed to assess the effects of early intensive blood pressure lowering in patients with acute intracerebral hemorrhage).SettingClinical hospital sites in 21 countries.PatientsPatients with predominantly mild-moderate severity of spontaneous intracerebral hemorrhage within 6 hours of onset and elevated systolic blood pressure (150-220 mm Hg) were included in the study.InterventionsPatients were assigned to receive intensive (target systolic blood pressure, < 140 mm Hg within 1 hr) or guideline-recommended (target systolic blood pressure, < 180 mm Hg) blood pressure-lowering therapy.Measurements And Main ResultsPresentation hyponatremia was defined as serum sodium less than 135 mEq/L. The primary outcome was death at 90 days. Multivariable logistic regression was used to assess the association of hyponatremia with important clinical events. Of 3,002 patients with available data, 349 (12%) had hyponatremia. Hyponatremia was associated with death (18% vs 11%; multivariable-adjusted odds ratio, 1.81; 95% CI, 1.28-2.57; p < 0.001) and larger baseline intracerebral hemorrhage volume (multivariable adjusted, p = 0.046) but not with baseline perihematomal edema volume nor with growth of intracerebral hemorrhage or perihematomal edema during the initial 24 hours.ConclusionsHyponatremia at presentation is associated with increased mortality in patients with predominantly deep and modest volume intracerebral hemorrhage through mechanisms that seem independent of growth in intracerebral hemorrhage or perihematomal edema.

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