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Blood Pressure Management in ICH

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Intracerebral Hemorrhage Therapeutics

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Abstract

Elevated systolic blood pressure is very common in patients with acute intracerebral hemorrhage, and it is a well-recognized risk factor for hematoma expansion, neurological deterioration, and poor clinical outcome in these patients. Multiple clinical trials have indicated the safety of acute blood pressure lowering in patients with ICH. However, ATACH II and INTERACT II clinical trials both failed to demonstrate significant improvement in clinical outcome in patients with acute hypertensive intracerebral hemorrhage following intensive blood pressure reduction defined as systolic blood pressure less than 140 mmHg in comparison to standard systolic blood pressure reduction to less than 180 mmHg. It is important to emphasize that the safety and efficacy of intensive blood pressure lowering in patients with unfavorable characteristics such as hematoma volume greater than 30 ml, midline shift, and increased intracranial pressure and patients with lower GCS score remain unclear as overwhelming majority of patients in ATACH II and INTERACT II trials had favorable baseline clinical characteristics. In summary, based on current data and until future trials provide further evidence on safety and efficacy of intensive blood pressure reduction in more specific and individualized subgroups of patients, systolic blood pressure lowering to 140–160 mmHg seems a reasonable blood pressure goal for patients with acute intracerebral hemorrhage.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Shahram Majidi

  2. University of Minnesota, Minneapolis, MN, USA

    Adnan I. Qureshi

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  1. Shahram Majidi
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  2. Adnan I. Qureshi
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Editor information

Editors and Affiliations

  1. University of California, San Francisco Medical Center, San Francisco, CA, USA

    Bruce Ovbiagele

  2. University of Minnesota, Minneapolis, MN, USA

    Adnan I. Qureshi

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Majidi, S., Qureshi, A.I. (2018). Blood Pressure Management in ICH. In: Ovbiagele, B., Qureshi, A. (eds) Intracerebral Hemorrhage Therapeutics. Springer, Cham. https://doi.org/10.1007/978-3-319-77063-5_4

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  • DOI: https://doi.org/10.1007/978-3-319-77063-5_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-77062-8

  • Online ISBN: 978-3-319-77063-5

  • eBook Packages: MedicineMedicine (R0)

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