American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients with intracranial hemorrhage, to what level should blood pressure be lowered?

1. 140/80 mm Hg

2. 160/90 mm Hg

3. 120/70 mm Hg

4. 180/100 mm Hg

The correct answer is: 160/90 mm Hg

In the management of patients with intracranial hemorrhage, the goal is to lower blood pressure to a level that reduces the risk of hematoma expansion while still maintaining adequate cerebral perfusion. Current guidelines recommend targeting a systolic blood pressure of approximately 160 mm Hg. This level is considered optimal, as it helps limit the risk of worsening the hemorrhage or causing secondary brain injury while still ensuring that the brain remains adequately perfused. A systolic target below 160 mm Hg, such as 140 mm Hg, may not provide sufficient perfusion pressure for the brain, especially in the context of cerebral edema or compromised perfusion due to the hemorrhage. Similarly, levels set at or below 120/70 mm Hg could also risk compromising cerebral perfusion. On the other hand, a threshold of 180/100 mm Hg is considered too high and poses a significant risk of further complications, including potential exacerbation of the hemorrhagic event. Therefore, a target of 160/90 mm Hg aligns with contemporary treatment protocols to balance the necessity of lowering blood pressure in the case of intracranial hemorrhage while ensuring cerebral protection and adequate blood flow.