Blood pressure management in acute intracerebral hemorrhage

current evidence and ongoing controversies

Abstract

Purpose of review 

Spontaneous intracerebral hemorrhage (ICH) is associated with high rates of morbidity and mortality. Although treatment options are limited, a potential acute medical intervention is blood pressure (BP) reduction. The review will summarize the current evidence and remaining knowledge gaps with respect to acute BP management in acute ICH.

Recent findings 

More than 3000 patients were enrolled in seven prospective randomized-controlled clinical trials assessing the safety and efficacy of intensive BP reduction (target <140–150 mmHg systolic) compared with current guideline-recommended BP target (<180 mmHg) in acute ICH. Overall, these trials demonstrated that intensive BP reduction is well tolerated and may be associated with a modest improvement in functional outcomes. There is still no conclusive evidence that aggressive BP reduction is associated with attenuation of hematoma growth or mortality rates. Delayed time to enrolment and difficulty in achieving intensive BP targets in a timely fashion without stringent antihypertensive protocols may partially account for the absence of proven benefit.

Summary 

Recent trials have shown that BP lowering (<140 mmHg systolic) is well tolerated and may improve functional outcomes. Ongoing trials will provide insight into the overall benefit of early aggressive BP reduction in acute ICH.