Target Systolic Blood Pressure in Hemorrhagic Stroke
The target systolic blood pressure for acute hemorrhagic stroke is 140-160 mmHg, to be achieved within 6 hours of symptom onset. 1
Acute Phase Management (First 6 Hours)
- Target SBP of 140-160 mmHg within 6 hours is the primary goal to prevent hematoma expansion and improve functional outcomes 1
- This recommendation comes from the most recent 2024 European Society of Cardiology guidelines, which specifically address hemorrhagic stroke management 1
- The mean arterial pressure should be maintained below 130 mmHg 1
- Cerebral perfusion pressure must remain at or above 60 mmHg at all times, particularly if elevated intracranial pressure is present 1
Evidence Supporting the 140-160 mmHg Target
The 2024 ESC guidelines represent the most current evidence, superseding older recommendations. Earlier 2010 AHA/ASA guidelines suggested targeting SBP to 140 mmHg for patients presenting with SBP 150-220 mmHg 2, but the updated guidance provides a more specific range of 140-160 mmHg 1.
Research evidence supports this approach:
- A Japanese multicenter study demonstrated that lowering SBP to 160 mmHg or less using nicardipine was well tolerated with low rates of neurological deterioration (8.1%) and serious adverse events (0.9%) 3
- The ATACH-2 trial showed that overly aggressive BP lowering (targeting 110-139 mmHg) did not improve outcomes compared to standard treatment (140-179 mmHg) and increased renal adverse events 4
Critical Safety Thresholds
- Avoid rapid, excessive BP reduction exceeding 70 mmHg within 1 hour, especially in patients presenting with SBP ≥220 mmHg, as this increases risk of acute renal injury and compromises cerebral perfusion 1
- The therapeutic window is narrow—delaying BP reduction beyond 6 hours reduces effectiveness in preventing hematoma expansion 1
- Allowing BP to remain above 160 mmHg systemically increases hematoma expansion risk 1
Answer to Your Question
Option B (140-160 mmHg) is correct based on the most recent 2024 ESC guidelines 1. Option A (120-140 mmHg) is too aggressive and not supported by current evidence—the ATACH-2 trial demonstrated that targeting SBP below 140 mmHg (specifically 110-139 mmHg) did not improve outcomes and increased complications 4.
Long-Term Management
After hospital discharge, target BP should be reduced to <130/80 mmHg for secondary stroke prevention 5, but this is distinct from acute phase management where 140-160 mmHg is the appropriate target 1.