The systolic blood pressure sweet spot after intracerebral hemorrhage

Abstract

Acute spontaneous intracerebral hemorrhage (ICH), the most severely disabling type of stroke, has few proven therapies. The mainstay of care remains acute blood pressure (BP)–lowering treatment, in order to mitigate hematoma expansion, perihematomal edema, and the attendant mass effects, each linked to early neurologic deterioration (END), death, and major disability.1,2 More than 5 randomized clinical trials (RCTs) have proven the safety and support the efficacy of early intensive BP-lowering treatment, as opposed to conservative BP control. These trials include the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 (INTERACT-2) and Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH-2) trials, which were recently compared3 and compiled in a large meta-analysis.4 Mounting evidence,1 particularly ad hoc analyses of INTERACT-2,5,6 suggests that the earlier the treatment, the steeper the drop, and the lower the BP achieved, the better the outcome,1,6 halting radiologic or clinical deterioration2 and, more importantly, improving quality of life and shifting toward better functional physical outcome at 3 months.4–6 Furthermore, INTERACT-2 data revealed a dose effect with linear relationship between achieved systolic BP (SBP) and reducing hematoma growth5 and improved functional outcome.6