Long-Term Blood Pressure Target After Hypertensive Intracerebral Hemorrhage

Guideline-Based Recommendation

• The American Heart Association/American Stroke Association guidelines recommend a blood pressure target of less than 140/90 mm Hg (or <130/80 mm Hg in the presence of diabetes or chronic kidney disease) for prevention of ICH recurrence 1

Evidence Supporting Intensive Blood Pressure Control

Recurrence Prevention

• Hypertension is the most consistently identified and most important modifiable risk factor for ICH recurrence, with recurrence rates of 2.1-3.7% per patient-year 1
• The PROGRESS trial demonstrated that blood pressure lowering significantly reduced the risk of first ICH (adjusted HR 0.44, 95% CI 0.28-0.69) and showed a similar trend for recurrent ICH (adjusted HR 0.37, 95% CI 0.10-1.38) 1
• This benefit appeared to apply to both lobar and deep hemispheric ICH 1

Avoid Excessive Reduction

• Rapid or excessive BP reduction should be avoided 1

Common Pitfalls to Avoid

• Do not confuse acute ICH management targets (140 mm Hg systolic) with long-term secondary prevention targets (<130/80 mm Hg) 2