Management of High Blood Pressure in Intracerebral Haemorrhage

Although intracerebral haemorrhage (ICH) represents a minority of all strokes, it remains a significant cause of morbidity and mortality worldwide. Early BP elevation is common after ICH, with many observations showing strong associations between increasing BP values and haematoma growth and subsequent poor outcomes. Recent evidence suggests that early intensive SBP lowering in acute ICH to <140 mmHg within a few hours is feasible and safe and can be effective in improving functional outcomes. The optimal timing for initiating BP lowering after ICH is unknown. However, optimal protection against death or disability after ICH was observed in patients without severe ICH and early planned surgery who achieved the greatest SBP reductions in the first hour after randomization, which was maintained consistently for 7 days. The optimal choice of drug and intensity of treatment remain elusive. Other factors, such as BP variability, obstructive sleep apnoea, obesity and other vascular risk factors, should also be considered in the acute care of ICH patients. Current large-scale trial results are needed to determine whether control of these potentially modifiable factors may improve clinical outcomes.