Reader response: Cerebral ischemia and deterioration with lower blood pressure target in intracerebral hemorrhage

We read with interest the study by Buletko et al.,¹ which found that the intensive lowering of systolic blood pressure (SBP) <140 mm Hg in acute intracerebral hemorrhage (ICH), particularly allowing SBP <120 mm Hg, was associated with increased remote cerebral ischemic lesions, neurologic deterioration during hospitalization, acute kidney injury, and longer days spent in the neurointensive care unit. These findings could point out the threshold of 130 mm Hg as a possible SBP sweet spot for safety, and confirmed the raised risk of renal failure in patients undergoing aggressive blood pressure (BP) reduction.^2,3 However, it would be interesting to also explore the associations between BP trajectories and either hematoma or perihemorrhagic edema course over the first 72 hours after the stroke onset. Indeed, it is controversial and a matter of ongoing debate whether early intensive BP control may effectively attenuate the ICH expansion.^2,4,5 This comprehensive analysis could also supply fresh clues to understand the lack of association between SBP target and functional or disposition status at discharge.¹