UMEM Educational Pearls

Category: Neurology

Title: BP Controversy: What's Ideal in ICH?

Keywords: Intracerebral hemorrhage, ICH, BP, variability, outcome (PubMed Search)

Posted: 8/28/2019 by WanTsu Wendy Chang, MD
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  • Elevated BP is common with acute ICH and is associated with hematoma expansion and worse outcome.
  • Early BP lowering in ICH appear to be safe, though did not improve outcomes in the two largest trials INTERACT2 and ATACH-II.
  • A preplanned pooled analysis of 3829 patients from these 2 trials found:
    • Every 10 mmHg reduction in SBP was associated with a 10% increase in odds of better functional recovery.
    • Reduced variability of SBP was associated with improved outcomes.
  • The association between BP variability and outcomes in ICH has been observed in several other recent studies.

Bottom Line: Reduced SBP variability is associated with improved outcomes in ICH.


  • Moullaali TJ, Wang X, Martin RH, et al. Blood pressure control and clinical outcomes in acute intracerebral hemorrhage: a preplanned pooled analysis of individual participant data. Lancet Neurol 2019;18(9):857-64.
  • Chung PW, Kim JT, Sanossian N, et al. Association between hyperacute blood pressure variability and outcome in patients with spontaneous intracerebral hemorrhage. Stroke 2018;49(2):348-54.
  • Divani AA, Liu X, Di Napoli M, et al. Blood pressure variability predicts poor in-hospital outcomes in spontaneous intracerebral hemorrhage. Stroke 2019;50(8):2023-9.

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