Blood pressure control

With increased intracranial pressure there is an increase in cerebral venous pressure and a reduction in perfusion pressure. Therefore it is hazardous to lower arterial pressure (Lavin.J.986), despite the fact that recurrent or continued bleeding is more likely at elevated blood pressure. Hypertension is also believed to exacerbate vasogenic edema around the hematoma. Autoregulation of cerebral blood flow is lost after cerebral hemorrhage, as after cerebral infarction, thus adding to the risk of inducing cerebral ischemia if systemic blood pressure falls. In practice it may be necessary to reduce high arterial pressure if it is causing other problems such as left ventricular failure, or if it is very high with attendant fears of rebleeding (e.g. 180/120). The choice of pharmacological regimen should be for agents with a smooth slow effect (e.g. intravenous b-blockers). Pressures as 'normal' as 120/80 may be hazardous; therefore no more than a modest reduction (e.g. 25 per cent) should be attempted.

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