Blood Pressure in Intracerebral Hemorrhage — How Low Should We Go?

  • Frontera J
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Intracerebral hemorrhage is one of the most devastating forms of stroke. The median 1-month case fatality rate is 40%, and only 12 to 39% of patients achieve functional independence.1 Although previous trials of therapies for patients with this condition have not shown a benefit with respect to outcome,2,3 targeted blood-pressure management after an intracerebral hemorrhage has been both a promising and a contentious area of recent study. Early elevations of blood pressure are common after an intracerebral hemorrhage, and many have debated whether this response is adaptive (to maintain perfusion to an ischemic penumbra surrounding the hematoma) or potentially deleterious (resulting in rebleeding, perihematoma edema expansion, or both). Current American Heart Association guidelines suggest a target mean arterial pressure of less than 110 mm Hg or a blood pressure of less than 160/90 mm Hg, with some consideration given to maintaining a reasonable cerebral perfusion pressure in patients with suspected elevations of intracranial pressure.4 These guidelines, however, acknowledge that this blood-pressure target is arbitrary and not evidence-based. A lower-level recommendation was given for reducing blood pressure to a systolic target of 140 mm Hg. This recommendation was based, in part, on the promising pilot results of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT), which showed a small, but significant, attenuation in hematoma growth over the course of 72 hours with aggressive lowering of blood pressure (systolic pressure of

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  • Jennifer A. Frontera

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