Synaptogenesis Pearls
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| 18 | Anti hypertensive drug choice in ICH
For most patients with an initial SBP ≥160 mmHg, we prefer nicardipine for initial treatment because it is fast-acting and can be quickly titrated.
Blood pressure is monitored every five minutes and patients are monitored at least hourly to assess for neurologic deterioration.
For most patients with an initial SBP <160 mmHg, we start with labetalol for its ease of administration and long duration of effect.
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Nitroprusside and nitroglycerin are typically avoided because they may increase intracranial pressure.
UpToDate. | 165 |
| 19 | Reducing SBP below 130 mmHg in the first hours after ICH onset has not been shown clearly beneficial for reducing death or disability and may increase the risk of adverse events, including cerebral hypoperfusion and kidney injury.
UpToDate. | 115 |
| 20 | Blood pressure management in ICH
For patients with acute ICH who present with systolic blood pressure (SBP) between 150 and 220 mmHg, we suggest lowering of SBP to a target of 140 mmHg, ideally within the first one hour of presentation, provided the patient remains clinically stable.
This degree of blood pressure reduction appears safe in most patients and may improve functional outcome.
For patients with acute ICH who present with SBP >220 mmHg, we suggest rapid lowering of SBP to <220 mmHg. Thereafter, the blood pressure is gradually reduced (over a period of hours) to a target range of 140 to 160 mmHg, provided the patient remains clinically stable.
Patients who deteriorate clinically during this period may require reduction of acute antihypertensive therapy.
The optimal blood pressure goal is uncertain, but an SBP of 140 to 160 mmHg is a reasonable target for patients who remain clinically stable. | 134 |
