Neuro Critical Care – Blood pressure and Intracranial Haemorrhage by Celia Bradford
Join Celia Bradford as she discusses blood pressure control in intracranial haemorrhage in neuro critical care.
Intracranial haemorrhage risk factors include hypertension. The question becomes, what do you do with hypertension in the management of intracranial haemorrhage?
Does blood pressure being high cause the bleed to be more severe or does a severe bleed cause increased blood pressure? It is a classic chicken or egg scenario.
Celia takes you through two prominent trials in the area and gives you valuable and practical tips on how to manage these patients.
The INTERACT-1 trial looked at haematoma expansion in two groups randomised to blood pressures of <180mmHg or <140mmHg systolic. This trial suggested benefit in patients treated with more aggressive blood pressure control.
INTERACT-2 was a much larger trial looked at controlling blood pressure within 6 hours in patients with blood pressures between 150-220mmHg systolic. They used the same parameters for two groups (<180mmHg or <140mmHg systolic) and the results were less clear when comparing intensive and standard blood pressure control targets.
ATACH-2 also looked at outcomes of tight control of blood pressure control. Two groups were randomised to 110-140mmHg or 140-180mmHg. This study demonstrated no benefit to more aggressive control of blood pressure and the group with more intensive treatment had worse renal outcomes.
There were also some issues with the study that Celia discusses. There is an unanswered question in that controlling blood pressure too aggressively may impact the penumbra (which may or may not exist!) Celia’s thinking from all of this? Aim blood pressure targets low but not too low (130-150mmHg). Aim for smooth control. Chose agents with a rapid onset of action and avoid agents such as SNP/GTN.
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Celia Bradford is an intensivist at Royal North Shore and Sydney Adventist Hospitals. She has an interest in Neurointensive Care and Renal Medicine. Her research has been in these areas. In addition, she writes for “The Bottom Line”, an online blog that reviews and critiques critical care literature and is interested in converting research findings into clinical practice. She is an advocate for women in Intensive Care and provides mentorship for aspiring Intensivists