COMMENTARY

Rapid BP Lowering in Acute Intracerebral Hemorrhage: Risky?

Henry R. Black, MD

Disclosures

August 22, 2013

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Lowering Blood Pressure After Intracerebral Hemorrhage: Fast or Slow?

Hi. I am Dr. Henry Black, Clinical Professor of Internal Medicine at the Langone New York University School of Medicine, a member of the Center for the Prevention of Cardiovascular Disease at that institution, and former President of the American Society of Hypertension.

An issue that has been gnawing at us for a long time is what to do with a patient with an intracerebral hemorrhage who comes in to the hospital. You are afraid to lower the patient's blood pressure too far and too fast out of concern for reduced perfusion to the brain, because it is well known that when an intracranial hemorrhage increases intracranial pressure, blood pressure almost invariably goes up. If you lower blood pressure too fast, you might underperfuse parts of the brain -- the so-called penumbra that is still viable -- and then you might extend the stroke and not do the patient any good.

A pilot study called INTERACT,[1] which was conducted in Europe and Asia, suggested that lowering blood pressure might be safe. INTERACT2[2] was just published, which is a larger study that compared lowering blood pressure in the first hour to less than 140 mm Hg (intensive group) compared with what the guidelines recommended, which was 150 -220 mm Hg, and stopping treatment at 6 hours rather than 1 hour (control group). This is a very important question, and it is interesting that two thirds of the subjects -- and I don't call people who are in a clinical trial patients; they are subjects -- were from China, where stroke is a major issue right now, more so than it is in the rest of the world.

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