Blood Pressure Management in ICH

  • Shahram Majidi
  • Adnan I. Qureshi


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.


Intracerebral hemorrhage Systolic blood pressure Acute hypertensive response Antihypertensive therapy Intensive blood pressure reduction Hematoma expansion Safety Neurological deterioration Clinical outcome 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Shahram Majidi
    • 1
  • Adnan I. Qureshi
    • 2
  1. 1.Department of NeurosurgeryIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.University of MinnesotaMinneapolisUSA

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