A lower rate of death or disability was not achieved among patients with intracerebral hemorrhage treated to achieve a target systolic blood pressure of 110 to 139 mm/Hg compared to standard reduction to a target of 140 to 179 mm/Hg. This according to a study of 1,000 participants (mean age 61.9 years) with intracerebral hemorrhage and a mean systolic blood pressure of 200.6±27.0 mm/Hg at baseline; 500 were assigned to intensive treatment and 500 to standard treatment. Researchers found:

• The primary outcome of death or disability was observed in 38.7% of participants in the intensive-treatment group and in 37.7% in the standard-treatment group (RR, 1.04).

• Serious adverse events occurring within 72 hours after randomization and considered to be treatment-related were reported in 1.6% of patients in the intensive-treatment group and in 1.2% of those in the standard-treatment group.

• Rate of renal adverse events within 7 days after randomization was significantly higher in the intensive-treatment group vs the standard-treatment group (9.0% vs 4.0%).

Citation: Qureshi AI, Palesch YY, Barsan WG, et al. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. [Published online ahead of print June 8, 2016]. N Engl J Med. doi:10.1056/NEJMoa1603460.

Commentary: Intracerebral hemorrhage typically leads to an increase in systolic blood pressure, greater than that usually seen with ischemic strokes. This is believed to be due to the auto-regulation of cerebral blood flow that occurs in response to increased intracerebral pressure, such that systemic blood pressure increases to maintain blood flow to the brain. The concern is that increases in blood pressure could contribute to expansion of the hemorrhage, while blood pressure that is too low may decrease blood flow to the area of the brain around the hemorrhage. This study shows that there is not a benefit of achieving a target systolic blood pressure of 110 to 139 mm/Hg compared to reduction to a target of 140 to 179 mm/Hg. —Neil Skolnik, MD