title: Blood Pressure Management in Intracranial Hemorrhage: Current Challenges and Opportunities.
abstract: Non-traumatic intracranial hemorrhage (i.e. intracerebral hemorrhage [ICH] and subarachnoid hemorrhage [SAH]) are more life threatening and least treatable despite being less common than ischemic stroke. Elevated blood pressure (BP) is a strong predictor of poor outcome in both ICH and SAH. Data from a landmark clinical trial INTERACT 2, wherein 2839 participants enrolled with spontaneous ICH were randomly assigned to receive intensive (target systolic BP <140 mmHg) or guideline recommended BP lowering therapy (target systolic BP <180 mmHg), showed that intensive BP lowering was safe, and more favorable functional outcome and better overall health-related quality of life were seen in survivors in the intensive treatment group. These results contributed to the shift in European and American guidelines towards more aggressive early management of elevated BP in ICH. In contrast, the treatment of BP in SAH is less well defined and more complex. Although there is consensus that hypertension needs to be controlled to prevent rebleeding in the acute setting, induced hypertension in the later stages of SAH has questionable benefits.
authors.affiliation: Neurological and Mental Health Division, The George Institute for Global Health, Sydney, NSW, Australia.|Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.|Neurology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Carcel
authors.affiliation: Neurological and Mental Health Division, The George Institute for Global Health, Sydney, NSW, Australia.
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Sato
authors.affiliation: Neurological and Mental Health Division, The George Institute for Global Health, Sydney, NSW, Australia. canderson@georgeinstitute.org.au.|Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. canderson@georgeinstitute.org.au.|Neurology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. canderson@georgeinstitute.org.au.|The George Institute for Global Health, PO Box M201, Missenden Road, Sydney, NSW, 2050, Australia. canderson@georgeinstitute.org.au.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Anderson
keywords: Blood pressure; Hypertension; Intensive blood pressure lowering; Intracerebral hemorrhage