Blood pressure in acute intracerebral haemorrhage

Abstract

Stroke is one of the leading causes of death worldwide, and spontaneous bleeding into the brain parenchyma, intracerebral haemorrhage (ICH), is a stroke subtype associated with high morbidity and mortality. Overall, it comprises about 15% of all stroke in Caucasians, this figure being much higher in Asians and black people. Blood pressure (BP) appears to play an important role in this disease. We have reviewed available literature on the relationship of BP to the occurrence of primary and secondary ICH, the association of BP levels measured early after stroke with prognosis and complications, and evidence about the effects of early BP lowering treatments on post-stroke outcomes. BP appears to be an important risk factor for primary and secondary ICH. In addition, high BP early after ICH may be detrimental to outcome, possibly contributing to complications such as rebleeding and haematoma enlargement. Few data are available about the effects of early lowering of BP on outcome after ICH with no reliable trial yet conducted. Proper randomised trials are required to establish the effect of early lowering of BP on outcome after ICH.

Differentiating ischemic from hemorrhagic stroke using plasma biomarkers: The S100B/RAGE pathway

“…In fact, specific management and treatment protocols are recommended for each stroke subtype. For instance, reducing the blood pressure in acute ICH may prevent or delay hematoma growth [3] and also decrease the risk of rebleeding [4], improving the clinical outcome [5]. On the contrary, lowering blood pressure may be deleterious in ischemic stroke [6,7].…”

Thrombin and hemin as central factors in the mechanisms of intracerebral hemorrhage–induced secondary brain injury and as potential targets for intervention

“…Intracerebral hemorrhage can be further distinguished from SAH as it is more commonly found near gray-white junctions in cerebral lobes, subcortical structures such as the basal ganglia, the brainstem, and deep cerebellar nuclei. 99,101 Current management for ICH immediately after onset involves airway management, monitoring of hemodynamic parameters, control of intracranial pressure, and hematoma evacuation.…”

Antihypertensive Treatment of Acute Intracerebral Hemorrhage by Intravenous Nicardipine Hydrochloride: Prospective Multi-Center Study

“…Furthermore, because of chronic hypertension, large proportions of patients with ICH have cardiac hypertrophy and diastolic dysfunction and decompensate in the presence of high afterload. Therefore, investigators are recently recommending treatment of acute hypertension using antihypertensive medication in patients with ICH (2, 3, 9-17, 21, 31, 32). …”

“…Factors commonly reported to be associated with poor outcome include hematoma enlargement. Lowering BP is commonly practiced to prevent hematoma enlargement in patients with ICH (2, 3, 9-14). However, the association between elevated BP and hematoma enlargement remains unclear.…”

“…On the other hand, there may be areas of disturbed cerebral autoregulation resulting in increased intracranial pressure and focal ischemia adjacent to a hematoma, and reduction of BP has been assumed to promote hypoperfusion and further ischemia. Elevated BP could also be a protective Cushing-Kocher response to preserve cerebral perfusion (2, 3, 8, 10, 13, 15-22). …”