An overview of acute hypertensive response following intracerebral hemorrhage: implifications for clinical practice

Abstract

The acute hypertensive response, elevated blood pressure in the acute phase of intracerebral hemorrhage, is very common and is associated with hematoma expansion, cerebral edema formation, intracranial pressure elevation, and poor long-term outcomes. This has led to the acceptance of antihypertensive treatment of acute hypertensive response as a mainstay of intacerebral hemorrhage management to reduce hematoma expansion and the associated disability and mortality. Intensive lowering of systolic blood pressure in the acute phase of intracerebral hemorrhage with varying intensity of systolic blood pressure reduction has been evaluated in several clinical trials. Some of these trials showed little benefit with intensive systolic blood pressure reduction compared with moderate or standard blood pressure reduction, while some showed no benefit and despite the large amount of literature, optimal approaches are not yet clear. In this review article, we summarized the current knowledge of the mechanisms underlying acute hypertensive response and the recent guidelines on the treatment of the acute hypertensive response provided by professional organizations and results of clinical trials and discussed incorporation of these concepts into clinical practice.

Keywords

Acute hypertensive response / intracerebral hemorrhage / hematoma expansion / blood pressure reduction / stroke

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