Blood pressure thresholds in the ICU

Maria Lorenza Muiesan, MD, is a professor of internal medicine at the University of Brescia, Italy. Her research focuses on cardiovascular abnormalities and use of cardiovascular drugs in hypertension and heart failure.

What is the blood pressure (BP) threshold that should trigger treatment in the intensive care unit (ICU)? Can we generalize?

Maria Lorenza Muiesan, MD: The threshold may be different from one clinical picture to another. If we have an acute ischemic stroke, we usually do not reduce BP aggressively because the increase in BP is in some way compensatory to the ischemia, and lowering BP may worsen the extension of the penumbra.

The opposite is done in hemorrhagic stroke, in which we can be aggressive and treat the patient down to 140 over <90 mm Hg. There are not really clearly defined thresholds. The point is that if you find the BP grade 3, usually 180/120 mm Hg or 180/110 mm Hg, you should lower BP, except for the ischemic stroke.