[Skip to Navigation]
September 8, 2020

Intensive Blood Pressure Reduction in Patients With Intracerebral Hemorrhage and Extreme Initial Hypertension: Primum Non Nocere

Author Affiliations
  • 1Department of Neurology, Northwestern University, Chicago, Illinois
  • 2Department of Anesthesiology, Northwestern University, Chicago, Illinois
JAMA Neurol. 2020;77(11):1351-1352. doi:10.1001/jamaneurol.2020.3081

Among factors associated with functional outcomes after intracerebral hemorrhage (ICH), hematoma growth consistently emerges as the most relevant potentially modifiable risk factor for poor outcomes.1,2 Short-term treatment strategies to reduce hematoma growth have pursued 2 pathways: improving hemostasis and reducing extravasation by means of blood pressure reduction. Basic principles of fluid mechanics suggest that a larger pressure gradient across the arteriole wall will increase the likelihood of rerupturing and, in the case of incomplete thrombosis of the ruptured vessel wall, will increase the rate of extravasation. In patients with aneurysmal subarachnoid hemorrhage, in whom vessel rerupture is a more readily ascertained event, studies indicate that higher systolic blood pressure (SBP) is a risk factor for rebleeding. In ICH, the presence of perihematomal contrast extravasation (called the spot sign) indicates ongoing extravasation and is associated with higher blood pressure. Evidence linking blood pressure, perihematomal edema, and outcomes has been reported but is less well established.3 It is on this foundation that rapid blood pressure reduction has been pursued as a protective strategy.

Add or change institution
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words