Intensive blood pressure lowering provides no additional benefits and results in more adverse events.

Commentary on : Qureshi AI, Palesch YY, Barsan WG, et al. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. N Engl J Med 2016;375:1033-43. Elevated blood pressure (BP) in acute intracerebral haemorrhage (ICH) is common and associated with poor outcome. High BP causes an expansion of the intracerebral haematoma, and the ‘Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial’ (INTERACT2) showed that moderate BP lowering <140 mm Hg is safe and likely to reduce death and major disability.1 The results of the INTERACT2 trial changed current guidelines.2 However, it is unclear whether very intensive BP lowering is of any further benefit for patients with ICH. The ‘Antihypertensive Treatment of Acute Cerebral Hemorrhage 2’ (ATACH-2) trial was a randomised, multicentre, open-label trial of intensive versus standard BP lowering …