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Blood Pressure Management After Intracerebral Hemorrhage

  • Critical Care Neurology (K Sheth, Section Editor)
  • Published:
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Opinion statement

Elevated blood pressure (BP), which presents in approximately 80 % of patients with acute intracerebral hemorrhage (ICH), is associated with increased risk of poor outcome. The Second Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT2) study, a multinational, multicenter, randomized controlled trial published in 2013, demonstrated better functional outcomes with no harm for patients with acute spontaneous ICH within 6 h of onset who received target-driven, early intensive BP lowering (systolic BP target <140 mmHg within 1 h, continued for 7 days) and suggested that greater and faster reduction in BP might enhance the treatment effect by limiting hematoma growth. The trial resulted in revisions of guidelines for acute management of ICH, in which intensive BP lowering in patients with acute ICH is recommended as safe and effective treatment for improving functional outcome. BP lowering is also the only intervention that is proven to reduce the risk of recurrent ICH. Current evidences from several randomized trials, including PROGRESS and SPS3, indicate that long-term strict BP control in patients with ICH is safe and could offer additional benefits in major reduction in risk of recurrent ICH. The latest American Heart Association/American Stroke Association (AHA/ASA) guidelines recommended a target BP of <130/80 mmHg after ICH, but supporting evidence is limited. Randomized controlled trials are needed that focus on strict BP control, initiated early after onset of the disease and continued long-term, to demonstrate effective prevention of recurrent stroke and other major vascular events without additional harms in the ICH population.

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Authors and Affiliations

  1. Neurological & Mental Health Division, The George Institute for Global Health, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, Sydney, 2050, NSW, Australia

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

  2. Sydney Medical School, The University of Sydney, Edward Ford Building A27, Sydney, 2006, NSW, Australia

    Cheryl Carcel MD & Craig S. Anderson MD, PhD

  3. Royal Prince Alfred Hospital, Level 11, King George V Building, 83-117 Missenden Rd, Camperdown, Sydney, 2050, NSW, Australia

    Cheryl Carcel MD & Craig S. Anderson MD, PhD

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Sato, S., Carcel, C. & Anderson, C.S. Blood Pressure Management After Intracerebral Hemorrhage. Curr Treat Options Neurol 17, 49 (2015). https://doi.org/10.1007/s11940-015-0382-1

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