Hypertension and Hemorrhagic Stroke

Abstract

Hemorrhagic strokes are common and account for 20 to 30% of all strokes in India and the rest of Asia. Patients admitted with intracerebral hemorrhage (ICH) are usually sicker, and ICH is associated with worse outcomes (as compared with ischemic strokes). Hypertension is the commonest risk factor for spontaneous ICH, responsible for up to 80% of all cases of ICH, either alone or in combination with other etiological factors. Elevated blood pressure (BP) during the first few hours to days after ICH leads to worse outcomes (higher death and disability rates). This is because high BP is directly linked to hematoma expansion and increased mass effect. Therefore, rapid lowering of BP is recommended if systolic BP > 160 mm Hg. Intravenous labetalol and nicardipine are both equally safe and effective for this purpose. Survivors of ICH have a higher risk of developing recurrence of ICH both over the short term and over the long term. Aggressive BP lowering is recommended in ICH survivors postdischarge from the hospital. The target BP of <130/80 mm Hg should be maintained in them to reduce the risk of ICH recurrence.