From the Research
In patients with subdural hematoma, the blood pressure goal should generally be maintained below 140/90 mmHg to reduce the risk of hematoma expansion and rebleeding, with a target systolic blood pressure range of 100-140 mmHg for acute cases requiring surgical intervention, as supported by the most recent study 1. The management of blood pressure in patients with subdural hematoma is crucial to prevent further bleeding and maintain adequate cerebral perfusion pressure.
- The goal is to balance the risk of hematoma expansion and rebleeding with the need to maintain adequate cerebral perfusion pressure.
- Hypertension can worsen bleeding and edema, while hypotension may lead to cerebral ischemia in the setting of increased intracranial pressure.
- First-line medications for blood pressure control in these patients include labetalol (10-20 mg IV bolus, repeated as needed) or nicardipine (5-15 mg/hr IV infusion), as these agents have minimal effects on intracranial pressure, as shown in a study comparing the effectiveness and safety of these agents 2. The blood pressure management should be individualized based on the patient's baseline blood pressure, age, comorbidities, and neurological status.
- A study on blood pressure guideline adherence in patients with ischemic and hemorrhagic stroke in the neurointensive care unit setting found that optimal control of systolic blood pressure was achieved in only 28% of patients 3.
- Another study found that patients with mean systolic blood pressure <140 in the first 24 h of admission had a lower rate of hematoma expansion than those with systolic blood pressure > 140 1. Therefore, maintaining a systolic blood pressure between 100-140 mmHg is typically recommended for acute subdural hematomas requiring surgical intervention, until definitive treatment, as supported by the most recent and highest quality study 1.