Less aggressive BP lowering after intracranial probably leads to better outcomes

Commentary from the Cleveland Clinic describe research results that showed that people hospitalized for primary intracerebral hemorrhage (ICH) and managed with a systolic blood pressure (SBP) target of less than 140 mm Hg developed more acute cerebral ischemia on MRI and neurologic deterioration than patients whose SBP goal was less than 160 mm Hg. Patients with ICH secondary to trauma, vascular malformations or tumors were excluded, as were patients who had emergent surgical evacuation or digital subtraction angiography prior to MRI, or if death or withdrawal of life support occurred within the first 72 hours. Treatment involved IV nicardipine followed by oral antihypertensives. People treated to a lower BP target were observed to have a significantly higher rate of cerebral ischemia (32 vs. 16 percent; P = .047), a higher rate of neurological deterioration (19 vs. 5 percent; P = .022) and spent a longer time in hospital (median 7 days vs. 6 days; P = .02). Although this research is helpful, further investigation of the issue appears to be warranted.