Management of acute hypertensive response in patients with intracerebral hemorrhage.

Spontaneous intracerebral hemorrhage (ICH) is intra-parenchymal bleeding that may lead to localized hematoma formation. The hematoma can enlarge over a period of time, and directly contribute to neurological deterioration and death. Several studies have shown a relationship between acute hypertensive response and poor prognosis among patients with ICH; however, it is somewhat unclear whether hematomal expansion, is a cause or a result of elevated blood pressure (BP). Current AHA guidelines state MAP should be maintained <130 mmHg and systolic blood pressure (SBP) <180 mmHg. Two major clinical trials demonstrating tolerability and safety of aggressive BP management to BP <140 mmHg in the acute phase of ICH were the ATACH (2004-2008) and INTERACT (2005-2007) trials. ATACH II and INTERACT 2 trials are currently being conducted to demonstrate the efficacy of SBP reduction as the next step to the ATACH and INTERACT pilot trials.