American Board of Internal Medicine (ABIM) Certification Practice Exam

In hypertensive intracerebral hemorrhage, what is the target blood pressure to achieve in the outpatient setting?

1. 120/80 mm Hg

2. 130/80 mm Hg

3. 140/80 mm Hg

4. 150/90 mm Hg

The correct answer is: 130/80 mm Hg

In the management of patients who have experienced hypertensive intracerebral hemorrhage, achieving an appropriate target blood pressure is crucial for preventing further complications and reducing the risk of recurrent events. A target blood pressure of 130/80 mm Hg strikes a balance between minimizing the risk of further hemorrhage while avoiding the potential adverse effects of excessively aggressive blood pressure lowering. This specific target is based on the idea that a systolic blood pressure of around 130 mm Hg allows for adequate cerebral perfusion while still providing a protective effect against the propensity for further hemorrhagic strokes. Guidelines suggest that targeting this level can help manage post-hemorrhagic hypertension effectively, ensuring that blood pressure is controlled without leading to hypoperfusion of the brain. While lower targets, such as 120/80 mm Hg, might seem ideal for overall cardiovascular management, they can increase the risk of insufficient perfusion in these vulnerable patients. Conversely, higher targets—such as 140/80 mm Hg or 150/90 mm Hg—may not sufficiently mitigate the risk of subsequent hemorrhagic events. Therefore, achieving a blood pressure of 130/80 mm Hg is seen as a practical and evidence-based approach in this clinical scenario.