UMEM Educational Pearls

Category: Critical Care

Title: Blood Pressure Management in Intracerebral Hemorrhage (ICH)

Keywords: Intracerebral hemorrhage, intraparenchymal hemorrhage, ICH, IPH, hypertensive emergency, blood pressure, neurocritical care, nicardipine (PubMed Search)

Posted: 8/15/2016 by Daniel Haase, MD (Emailed: 9/6/2016) (Updated: 9/6/2016)
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--Aggressive BP management (SBP <140) in atraumatic intracerebral hemorrhage (ICH) does NOT signifcantly improve mortality or disability compared with traditional goal (SBP <180) [1]

--However, a lower goal (SBP <140) has been shown to decrease hematoma size and be safe compared to a higher goal (SBP <180) [2]


The recently published ATACH-2 study investigated aggressive BP control in hypertensive acute atraumatic ICH/IPH (intraparenchymal hemorrhage). [1]

--Control group SBP 140-179 mmHg vs. intervention group SBP 110-139 mmHg with nicardipine infusion (control group actually had SBP 140-150 vs. intervention group SBP 120-130 most of the time).

--Study stopped early for futility. No difference in mortality or modified Rankin.

Previously, INTERACT2 demonstrated that aggressive SBP management (<140) was safe, decreasing hematoma expansion leading to a change in some individuals' practice. [2]


1. Qureshi AI, Palesch YY, et al; ATACH-2 Trial Investigators and the Neurological Emergency Treatment Trials Network. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. N Engl J Med. 2016 Jun 8. [Epub ahead of print] PubMed PMID: 27276234.

2. Anderson CS, Heeley E, et al; INTERACT2 Investigators. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013 Jun 20;368(25):2355-65. doi: 10.1056/NEJMoa1214609. Epub 2013 May 29. PubMed PMID: 23713578.