Blood Pressure Management After Intracerebral and Subarachnoid Hemorrhage: The Knowns and Known Unknowns

Jatinder S. Minhas, Tom J. Moullaali, Gabriel J.e. Rinkel, Craig S. Anderson

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Blood pressure (BP) elevations often complicate the management of intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage, the most serious forms of acute stroke. Despite consensus on potential benefits of BP lowering in the acute phase of intracerebral hemorrhage, controversies persist over the timing, mechanisms, and approaches to treatment. BP control is even more complex for subarachnoid hemorrhage, where there are rationales for both BP lowering and elevation in reducing the risks of rebleeding and delayed cerebral ischemia, respectively. Efforts to disentangle the evidence has involved detailed exploration of individual patient data from clinical trials through meta-analysis to determine strength and direction of BP change in relation to key outcomes in intracerebral hemorrhage, and which likely also apply to subarachnoid hemorrhage. A wealth of hemodynamic data provides insights into pathophysiological interrelationships of BP and cerebral blood flow. This focused update provides an overview of current evidence, knowledge gaps, and emerging concepts on systemic hemodynamics, cerebral autoregulation and perfusion, to facilitate clinical practice recommendations and future research.

Original languageEnglish
Pages (from-to)1065-1073
JournalStroke
Volume53
Issue number4
Early online date8 Mar 2022
DOIs
Publication statusPublished - 1 Apr 2022

Keywords / Materials (for Non-textual outputs)

  • blood pressure
  • cerebral hemorrhage
  • hypertension
  • perfusion
  • subarachnoid hemorrhage

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