Related Experiment Video
Updated: Aug 23, 2025
Intracranial Pressure Monitoring In Nontraumatic Intraventricular Hemorrhage Rodent Model
Published on: February 8, 2022
Blood Pressure Control Targets and Risk of Cardiovascular and Cerebrovascular Events After Intracerebral Hemorrhage
Kay-Cheong Teo1, Sophia Keins2,3,4, Jessica R Abramson2,3,4
1Department of Medicine, Queen Mary Hospital (K.-C.T., W.C.Y.L., I.Y.H.L., Y.-K.W., C.Y., K.-K.L.), LKS Faculty of Medicine, The University of Hong Kong.
Insights
Lowering systolic blood pressure (BP) below 120 mmHg in intracerebral hemorrhage (ICH) survivors may reduce recurrent stroke and cardiovascular events. However, this intensive BP control might increase mortality in older patients or those with severe disability.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Intracerebral hemorrhage (ICH) survivors face a high risk of recurrent stroke and cardiovascular events.
- Optimal blood pressure (BP) targets for these patients are not well-established.
- Current guidelines recommend BP <130/80 mmHg, but lower targets may be beneficial.
Purpose of the Study:
- To investigate if intensive BP control (systolic BP <120 mmHg) in ICH survivors reduces major adverse cardiovascular and cerebrovascular events (MACCEs) and mortality.
- To identify optimal BP targets for secondary prevention after ICH.
Main Methods:
- Analysis of data from 1828 spontaneous ICH survivors across two cohort studies.
- BP measurements recorded at 3, 6, and every 6 months thereafter post-ICH.
- Outcomes included recurrent ICH, ischemic stroke, myocardial infarction, vascular mortality, and all-cause mortality.
Main Results:
- A median follow-up of 46.2 months revealed 166 recurrent ICH, 68 ischemic strokes, 69 myocardial infarctions, and 429 deaths.
- Systolic BP <120 mmHg was associated with reduced risk of recurrent ICH (AHR 0.74) and MACCEs (AHR 0.69) compared to 120-129 mmHg.
- No significant difference in all-cause or vascular mortality, but increased all-cause mortality with systolic BP <120 mmHg in patients >75 years or with mRS 4-5.
Conclusions:
- Targeting systolic BP <120 mmHg may decrease MACCE risk in select ICH survivors without increasing overall mortality.
- Intensive BP control requires careful consideration in elderly patients or those with significant disability.
- Further investigation in randomized controlled trials is warranted to confirm these findings.
Background:
Intracerebral hemorrhage (ICH) survivors are at high risk for recurrent stroke and cardiovascular events. Blood pressure (BP) control represents the most potent intervention to lower these risks, but optimal treatment targets in this patient population remain unknown. We sought to determine whether survivors of ICH achieving more intensive BP control than current guideline recommendations (systolic BP <130 mmHg and diastolic BP <80 mmHg) were at lower risk of major adverse cardiovascular and cerebrovascular events and mortality.
Methods:
We analyzed data for 1828 survivors of spontaneous ICH from 2 cohort studies. Follow-up BP measurements were recorded 3 and 6 months after ICH, and every 6 months thereafter. Outcomes of interest were major adverse cardiovascular and cerebrovascular events (recurrent ICH, incident ischemic stroke, myocardial infarction), vascular mortality (defined as mortality attributed to recurrent ICH, ischemic stroke, or myocardial infarction), and all-cause mortality.
Results:
During a median follow-up of 46.2 months, we observed 166 recurrent ICH, 68 ischemic strokes, 69 myocardial infarction, and 429 deaths. Compared with survivors of ICH with systolic BP 120 to 129 mmHg, participants who achieved systolic BP <120 mmHg displayed reduced risk of recurrent ICH (adjusted hazard ratio [AHR], 0.74 [95% CI, 0.59-0.94]) and major adverse cardiovascular and cerebrovascular events (AHR, 0.69 [95% CI, 0.53-0.92]). All-cause mortality (AHR, 0.76 [95% CI, 0.57-1.03]) and vascular mortality (AHR, 0.68 [95% CI, 0.45-1.01]) did not differ significantly. Among participants aged >75 years or with modified Rankin Scale score 4 to 5, systolic BP <120 mmHg was associated with increased all-cause mortality (AHR, 1.38 [95% CI, 1.02-1.85] and AHR, 1.36 [95% CI, 1.03-1.78], respectively), but not vascular mortality. We found no differences in outcome rates between survivors of ICH with diastolic BP <70 versus 70 to 79 mmHg.
Conclusions:
Targeting systolic BP <120 mmHg in select groups of survivors of ICH could result in decreased major adverse cardiovascular and cerebrovascular events risk without increasing mortality. Our findings warrant investigation in dedicated randomized controlled trials.
Related Concept Videos
01:18Hypertension and Regulation of Blood Pressure
01:25Errors occurring during blood pressure monitoring
Several factors...
01:23Hypertension V: Nursing Management
01:24Blood Pressure Imbalances and Circulatory Shock
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
01:30Blood Pressure
The average BP in an adult is typically around 120/80 mmHg (millimeters of mercury). In this measurement, the numerator (120) indicates the systolic pressure, which is the pressure in the arteries during the contraction of the heart's ventricles as blood is expelled. The denominator (80) represents the...
01:28Hypertension IV: Drug Therapy and Lifestyle Modifications