UMEM Educational Pearls

Category: Critical Care

Title: Blood Pressure and ICH

Keywords: blood pressure, intracerebral hemorrhage (PubMed Search)

Posted: 12/31/2008 by Mike Winters, MD (Updated: 10/22/2020)
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Blood Pressure Control in ICH

  • Aggressive BP reduction after ICH is currently the focus of an ongoing NINDS study (ATACH Study)
  • Current literature recommends that extreme levels of BP after ICH be treated to reduce hematoma expansion
  • Mean arterial pressures (MAP) > 130 mmHg should be treated with continous IV medications
  • Current recommended medications include labetalol, esmolol, nicardipine, and fenoldopam
  • Nitroprusside is avoided by many given its tendency to increase ICP
  • Oral and sub-lingual medications are not indicated for immediate and precise BP control

References

Rincon F, Mayer SA. Clinical review: critical care management of spontaneous intracerebral hemorrhage. Crit Care 2008;12:237.