American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended systolic blood pressure target for patients with hypertensive intracerebral hemorrhage at risk for hematoma expansion?

1. 150 mm Hg

2. 160 mm Hg

3. 140 mm Hg

4. 130 mm Hg

The correct answer is: 140 mm Hg

The recommended systolic blood pressure target for patients with hypertensive intracerebral hemorrhage at risk for hematoma expansion is 140 mm Hg. This target is based on clinical studies that suggest maintaining systolic blood pressure in this range can reduce the risk of further bleeding while not compromising cerebral perfusion. In the context of acute intracerebral hemorrhage, aggressively managing high blood pressure is crucial as it can lead to edema and secondary injury if not controlled. The 140 mm Hg target is considered a balance between preventing potential complications from very high blood pressure and maintaining adequate blood flow and oxygen to the brain. Studies like the ATACH trial have influenced these guidelines, demonstrating that a target systolic pressure of less than or equal to 140 mm Hg during the first few hours after hemorrhage can be beneficial in managing patients at risk for hematoma expansion. The choice of a target higher or lower than 140 mm Hg may not provide the same protective benefits and could potentially increase the risk of complications, making 140 mm Hg the recommended approach in clinical practice for these patients.