A 62-year-old man presents with sudden right hemiparesis. Non-contrast CT confirms a spontaneous left basal ganglia intracerebral hemorrhage, 25 mL volume. Current BP is 205/110 mmHg. According to AHA guidelines, to what systolic range should BP be lowered acutely, provided he is alert with GCS 15?
- A To 130 to 140 mmHg ✓
- B Below 100 mmHg
- C To 160 to 180 mmHg
- D No lowering until repeat CT at 6 hours
Correct answer: A. To 130 to 140 mmHg
Explanation
For spontaneous intracerebral hemorrhage presenting with systolic BP above 220 mmHg, guidelines recommend aggressive reduction to around 140 mmHg, supported by the INTERACT2 trial showing safety and functional benefit. The 160 to 180 mmHg range applies when presentation SBP exceeds 150 mmHg but is below 220 mmHg with only modest lowering tolerated. Lowering below 100 mmHg risks cerebral hypoperfusion and is never targeted.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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