Review of Long-Term Blood Pressure Control After Intracerebral Hemorrhage: Challenges and Opportunities

So we still have NO FUCKING CLUE what a blood pressure management protocol is. Hope you don't mind dying because of the cesspools of incompetence of the complete stroke medical world.  Unless YOU hold your stroke hospital's feet to the fire you are allowing your children and grandchildren to die or become disabled from their strokes.

• blood pressure management (43 posts to June 2017)

5 years and still incompetent leadership in stroke.

 

Review of Long-Term Blood Pressure Control After Intracerebral Hemorrhage: Challenges and Opportunities

Michael T. Mullen

and

Craig S. Anderson

Originally published3 Jun 2022https://doi.org/10.1161/STROKEAHA.121.036885Stroke. 2022;0:10.1161/STROKEAHA.121.036885

Abstract

Blood pressure (BP) is the most important modifiable risk factor for intracerebral hemorrhage (ICH). Elevated BP is associated with an increased risk of ICH, worse outcome after ICH, and in survivors, higher risks of recurrent ICH, ischemic stroke, myocardial infarction, and cognitive impairment/dementia. As intensive BP control probably(NOT GOOD ENOUGH! Survivors need a protocol! GET THERE!) improves the chances of recovery from acute ICH, the early use of intravenous or oral medications to achieve a systolic BP goal of <140 mm Hg within the first few hours of presentation is reasonable for being applied in most patients. In the long-term, oral antihypertensive drugs should be titrated as soon as possible to achieve a goal BP <130/80 mm Hg and again in all ICH patients regardless of age, location, or presumed mechanism of ICH. The degree of sustained BP reduction, rather than the choice of BP-lowering agent(s), is the most important factor for optimizing risk reduction, with varying combinations of thiazide-type diuretics, long-acting calcium channel blockers, ACE (angiotensin-converting enzyme) inhibitors or angiotensin receptor blockers, being the mainstay of therapy. As most patients will require multiple BP-lowering agents, and physician inertia and poor adherence are major barriers to effective BP control, single-pill combination therapy should be considered as the choice of management where available. Increased population and clinician awareness, and innovations to solving patient, provider, and social factors, have much to offer for improving BP control after ICH and more broadly across high-risk groups. It is critical that all physicians, especially those managing ICH patients, emphasize the importance of BP control in their practice.

Footnotes

For Sources of Funding and Disclosures, see page xxx.

Correspondence to: Craig S. Anderson, MD, PhD, The George Institute for Global Health, Post PO Box M201, Missenden Rd, Camperdown, NSW 2050 Australia. Email canderson@georgeinstitute.org.au