From the Guidelines
The goal blood pressure for intraparenchymal hemorrhage is to maintain a systolic target of 140-160 mmHg to prevent hematoma expansion and improve functional outcome. This recommendation is based on the most recent guidelines from the European Heart Journal, which suggest that immediate blood pressure lowering within 6 hours of symptom onset is beneficial in patients with intracerebral hemorrhage 1.
When managing blood pressure in patients with intraparenchymal hemorrhage, it is essential to consider the potential risks and benefits of aggressive blood pressure lowering. While reducing blood pressure can help prevent hematoma expansion, it is crucial to avoid lowering blood pressure too drastically, as this may compromise cerebral perfusion pressure, particularly in patients with chronic hypertension who have altered cerebral autoregulation.
Some key considerations when managing blood pressure in these patients include:
- Avoiding acute reduction in systolic blood pressure >70 mmHg from initial levels within 1 hour of commencing treatment in patients with systolic blood pressure ≥220 mmHg 1
- Using first-line medications such as intravenous labetalol, nicardipine, or clevidipine to achieve target blood pressure
- Transitioning to oral antihypertensives once the patient is stable
- Monitoring blood pressure closely to avoid over-lowering or under-lowering blood pressure
It is also important to note that the ideal target blood pressure to prevent intracerebral hemorrhage recurrence is not yet known, and more research is needed to determine the optimal target blood pressure and timing of therapy 1. However, based on current evidence, maintaining a systolic target of 140-160 mmHg is recommended for patients with intraparenchymal hemorrhage.
From the Research
Goal Blood Pressure for Intraparenchymal Hemorrhage
- The goal blood pressure for intraparenchymal hemorrhage is a systolic BP in the range of 140 mmHg for small hemorrhages without intracranial hypertension 2.
- The 2022 American Heart Association and American Stroke Association guidelines recommend targeting a SBP of 140 mm Hg while maintaining the range of 130-150 mm Hg 3.
- A study found that intensive SBP reduction following ICH predisposes patients to secondary organ injury that may impact long-term outcomes, suggesting that a more modest lowering of the SBP within 48 h may minimize the risk of further adverse events 3.
- Another study found that SBP lowering to 160 mmHg or less using nicardipine appears to be well tolerated and feasible for acute ICH 4.
Blood Pressure Management
- Nicardipine and labetalol are two commonly used antihypertensives for treating elevated blood pressures in the setting of intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) 5, 6.
- A study found that both nicardipine and labetalol infusion are effective and safe for blood pressure management in patients with intracerebral and subarachnoid hemorrhage 6.
- Another study compared the safety, efficacy, and ease of administration of continuous-infusion labetalol with continuous-infusion nicardipine following an acute stroke, and found that both agents were comparable in the studied safety and efficacy outcomes 5.