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Blood Pressure Management After Intracerebral and Subarachnoid Hemorrhage: The Knowns and Known Unknowns

journal contribution
posted on 05.05.2022, 15:25 by Jatinder S Minhas, Tom J Moullaali, Gabriel JE Rinkel, Craig S Anderson
Blood pressure (BP) elevations often complicate the management of intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage, the most serious forms of acute stroke. Despite consensus on potential benefits of BP lowering in the acute phase of intracerebral hemorrhage, controversies persist over the timing, mechanisms, and approaches to treatment. BP control is even more complex for subarachnoid hemorrhage, where there are rationales for both BP lowering and elevation in reducing the risks of rebleeding and delayed cerebral ischemia, respectively. Efforts to disentangle the evidence has involved detailed exploration of individual patient data from clinical trials through meta-analysis to determine strength and direction of BP change in relation to key outcomes in intracerebral hemorrhage, and which likely also apply to subarachnoid hemorrhage. A wealth of hemodynamic data provides insights into pathophysiological interrelationships of BP and cerebral blood flow. This focused update provides an overview of current evidence, knowledge gaps, and emerging concepts on systemic hemodynamics, cerebral autoregulation and perfusion, to facilitate clinical practice recommendations and future research.

History

Citation

Stroke. 2022;53:1065–1073. https://doi.org/10.1161/STROKEAHA.121.036139

Author affiliation

Department of Cardiovascular Sciences, University of Leicester

Version

AM (Accepted Manuscript)

Published in

Stroke

Volume

53

Issue

4

Pagination

1065 - 1073

Publisher

Ovid Technologies (Wolters Kluwer Health)

issn

0039-2499

eissn

1524-4628

Acceptance date

08/03/2022

Copyright date

2022

Available date

08/09/2022

Spatial coverage

United States

Language

en