Management of acute hypertensive response in the ICH patient

Introduction About 37000 to 52400 people in the United States suffer from intracerebral hemorrhage (ICH) every year (1). Hypertension is the most important risk factor for spontaneous ICH accounting for about 60-70% of cases (2). Broderick et al. showed hypertension was the primary cause of ICH in 72% of the 188 patients evaluated in the study (3). Risk of ICH is increased in certain populations of hypertensive patients who are non-compliant with antihypertensive medication, are aged 55 years or younger, or are cigarette smokers. Hispanics, African Americans, Native Americans, and those of Asian ancestry have higher incidence of ICH related to hypertension(4-6). Nearly two-thirds of hypertensive patients have uncontrolled blood pressure (BP) (greater than 140/90 mmHg) at admission (7). Control of BP among patients with chronic hypertension reduces the incidence of intracerebral hemorrhage (8-10). Elevated BP, termed as acute hypertensive response (AHR), is observed in over 60% of patients coming to the ER (11). A large and nationally representative survey (12) showed that over 75% of ICH patients had systolic blood pressure (SBP) > 140 and 20% greater than 180 mmHg at presentation. Patients with stroke and high initial BP are at a 1.5-5.0-fold increased risk of death or dependency and clinical deterioration (13, 14).