Journal of Neurocritical Care 2017;10(1):36-40

doi:10.18700/jnc.160102

Adverse Effects of Aggressive Blood Pressure Control in Patients with Intracerebral Hemorrhage

Panagiotis MASTORAKOS 1 ; Kenneth C LIU ; Andrew SCHOMER

Affiliations

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Keywords

Intracerebral hemorrhage; Blood pressure; Hypoperfusion; Cerebral infarction

Country

Republic of Korea

Language

English

Abstract

BACKGROUND: Medical management of patients presenting with spontaneous intracerebral hemorrhage (ICH) is focused on blood pressure (BP) management. However, the BP goal to prevent ICH expansion remains controversial. Recent clinical trials have suggested that aggressive BP control is safe but may not have the previously thought benefits. CASE REPORT: We present an example of aggressive BP control in the setting of hypertensive ICH, in accordance to previously established protocols. This resulted in adverse effects in the form of acute kidney injury and watershed infarcts, which impeded the patients' recovery and prolonged his hospitalization. CONCLUSIONS: Hypertensive individuals have altered cerebral autoregulation curves shifted to the right and require higher arterial pressures to maintain adequate cerebral blood flow. Hence, aggressive BP reduction may result in cerebral hypoperfusion as well as other forms of end-organ damage.