Management of High Blood Pressure in Intracerebral Haemorrhage

High blood pressure (BP) is well established as the major contributor to intracerebral haemorrhage (ICH), with an even stronger association with ICH than with ischaemic stroke. BP values are linearly associated with the risk of ICH. High BP appears to play a critical role in the pathogenesis of ICH and is strongly related to haematoma growth and subsequent poor clinical outcomes. Haematoma expansion and final lesion volume are determined mainly within the first 24 h after stroke and are key prognostic factors of clinical outcomes. Excellent medical care probably has a potent, direct impact on ICH morbidity and mortality. Excellent medical care in the acute phase has a potent and direct impact on ICH morbidity and mortality. Therefore, the goal of ICH treatment is to prevent and reverse acute brain injury and prevent neurological impairment and disability. The evidence shows that management in an acute stroke unit improves outcomes compared with care on a general ward, reducing mortality and dependency in patients with ICH. However, management of acute BP elevation in ICH has been controversial for decades, and the guidelines recommendations have been modified based on the evidence of randomized controlled trials (RCTs). In this chapter, the most recent data from RCTs are widely discussed, and the available evidence is sufficient to postulate that in patients with spontaneous ICH of mild-to moderate severity with <6 h onset, early SBP lowering in a 140–130 mmHg range appears to be safe and beneficial for improving functional outcome. When ICH onset is ≥6 h, the BP management depends on the severity of SBP but a slow and moderate BP reduction to SBP < 180 mmHg is preferred over intensive BP lowering.