J Neurocrit Care.  2017 Jun;10(1):36-40. 10.18700/jnc.160102.

Adverse Effects of Aggressive Blood Pressure Control in Patients with Intracerebral Hemorrhage

• Mastorakos P
• Liu KC
• Schomer A

• KMID: 2385885
• DOI: http://doi.org/10.18700/jnc.160102

Abstract

BACKGROUND
Medical management of patients presenting with spontaneous intracerebral hemorrhage (ICH) is focused on blood pressure (BP) management. However, the BP goal to prevent ICH expansion remains controversial. Recent clinical trials have suggested that aggressive BP control is safe but may not have the previously thought benefits.
CASE REPORT
We present an example of aggressive BP control in the setting of hypertensive ICH, in accordance to previously established protocols. This resulted in adverse effects in the form of acute kidney injury and watershed infarcts, which impeded the patients' recovery and prolonged his hospitalization.
CONCLUSIONS
Hypertensive individuals have altered cerebral autoregulation curves shifted to the right and require higher arterial pressures to maintain adequate cerebral blood flow. Hence, aggressive BP reduction may result in cerebral hypoperfusion as well as other forms of end-organ damage.

Keyword

Intracerebral hemorrhage; Blood pressure; Hypoperfusion; Cerebral infarction

MeSH Terms

Acute Kidney Injury
Arterial Pressure
Blood Pressure*
Cerebral Hemorrhage*
Cerebral Infarction
Cerebrovascular Circulation
Homeostasis
Hospitalization
Humans

Figure

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  Figure 1. (A) CT head at presentation demonstrating score 1 thalamic ICH; (B) 3D reconstitution of bilateral carotid arteries demonstrating patent vasculature and no evidence of significant stenosis; (C), (D) CT angiogram demonstrating patent intracranial vasculature at presentation.

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  Figure 2. (A) Systolic and diastolic blood pressure during the first 10d of admission, the arrow indicates the time of detection of the stroke; (B) Daily volume balance, including in, out and net, during admission; (C) Daily creatinine (Cr) and glomerular filtration rate (GFR) during admission.

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  Figure 3. (A) MRI DWI and (B) MRI ADC demonstrating watershed infarcts.

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