From the Guidelines
For patients with intracerebral hemorrhage (ICH), the blood pressure goal is to acutely lower systolic blood pressure to 140 mmHg in those presenting with SBP between 150 and 220 mm Hg, as this is safe and can be effective for improving functional outcome 1. This recommendation is based on the guidelines for the management of spontaneous intracerebral hemorrhage from the American Heart Association/American Stroke Association, which suggests that acute lowering of SBP to 140 mmHg is safe (Class I; Level of Evidence A) and can be effective for improving functional outcome (Class IIa; Level of Evidence B) 1. Some key points to consider when managing blood pressure in ICH patients include:
- The choice of antihypertensive agent should take into account practicability, pharmacological profile, potential side effects, and cost 1
- For ICH patients presenting with SBP >220 mm Hg, aggressive reduction of BP with a continuous intravenous infusion and frequent BP monitoring may be reasonable (Class IIb; Level of Evidence C) 1
- Blood pressure should be monitored continuously or checked every 5-15 minutes during the acute phase to avoid excessive or rapid lowering of blood pressure, which could compromise cerebral perfusion. The goal of blood pressure management in ICH is to limit hematoma expansion, which typically occurs within the first few hours after hemorrhage and is associated with neurological deterioration and worse outcomes.
From the Research
Blood Pressure Goals for Intracerebral Hemorrhage (ICH)
- The blood pressure goal for ICH is generally considered to be a systolic blood pressure (SBP) of 140 mm Hg, as recommended by recent guidelines 2, 3, 4.
- This goal is supported by evidence from randomized clinical trials, which suggests that targeting an SBP of 140 mm Hg can improve outcomes in patients with acute ICH 3, 4.
- In one study, patients with ICH who received intravenous nicardipine to reduce their blood pressure had a target SBP range of 120-160 mm Hg 5.
- Another study found that reducing SBP to 140 mm Hg was generally well-tolerated in patients with ICH, without a significant risk of neurological worsening 3.
- The American Heart Association and other organizations recommend targeting an SBP of 140 mm Hg in patients with acute ICH, although the optimal blood pressure management strategy may vary depending on individual patient factors 2, 4.