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Blood Pressure Management in Intracranial Hemorrhage: Current Challenges and Opportunities

  • Cerebrovascular Disease and Stroke (N Rost, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Non-traumatic intracranial hemorrhage (i.e. intracerebral hemorrhage [ICH] and subarachnoid hemorrhage [SAH]) are more life threatening and least treatable despite being less common than ischemic stroke. Elevated blood pressure (BP) is a strong predictor of poor outcome in both ICH and SAH. Data from a landmark clinical trial INTERACT 2, wherein 2839 participants enrolled with spontaneous ICH were randomly assigned to receive intensive (target systolic BP <140 mmHg) or guideline recommended BP lowering therapy (target systolic BP <180 mmHg), showed that intensive BP lowering was safe, and more favorable functional outcome and better overall health-related quality of life were seen in survivors in the intensive treatment group. These results contributed to the shift in European and American guidelines towards more aggressive early management of elevated BP in ICH. In contrast, the treatment of BP in SAH is less well defined and more complex. Although there is consensus that hypertension needs to be controlled to prevent rebleeding in the acute setting, induced hypertension in the later stages of SAH has questionable benefits.

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Authors and Affiliations

  1. Neurological and Mental Health Division, The George Institute for Global Health, Sydney, NSW, Australia

    Cheryl Carcel MD, Shoichiro Sato MD, PhD & Craig S. Anderson MD, PhD

  2. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Cheryl Carcel MD & Craig S. Anderson MD, PhD

  3. Neurology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Cheryl Carcel MD & Craig S. Anderson MD, PhD

  4. The George Institute for Global Health, PO Box M201, Missenden Road, Sydney, NSW, 2050, Australia

    Craig S. Anderson MD, PhD

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  1. Cheryl Carcel MD
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Correspondence to Craig S. Anderson MD, PhD.

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Cheryl Carcel, Shoichiro Sato and Craig S. Anderson each declare no potential conflicts of interest.

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This article is part of the Topical Collection on Cerebrovascular Disease and Stroke

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Carcel, C., Sato, S. & Anderson, C.S. Blood Pressure Management in Intracranial Hemorrhage: Current Challenges and Opportunities. Curr Treat Options Cardio Med 18, 22 (2016). https://doi.org/10.1007/s11936-016-0444-z

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