Medical treatment of spontaneous intracranial hemorrhage by the use of hypotensive drugs

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Abstract
Acute, spontaneous intracranial hemorrhages in 312 patients have been carefully classified according to etiology. In each group, 2 comparable series otherwise unselected were treated conservatively in a comparable manner except that in 1 group hypotensive drugs were used to maintain the blood pressure at lower levels. In patients with ruptured aneurysm or primary hypertensive intracerebral hemorrhage, the survival rate was slightly better in the group given hypotensive drugs; the difference approached but failed to reach statistical significance. Those admitted in coma after rupture of a saccular aneurysm fared poorly whether they received hypotensive drugs or not. In view of the numerous contraindications to neurosurgical treatment in acute cases of ruptured aneurysm, it is concluded that hypotensive medical treatment is advisable in the acute stages of spontaneous intracranial hemorrhage, particularly if the blood pressure is elevated. Selection of cases for surgical treatment can then be assessed after arteriography and suitable clinical evaluation. In the two groups of patients suffering from hypertensive intracranial hemorrhage, there was a highly significant statistical difference between the survival rates of those receiving hypotensive drugs compared to those who did not. Those treated with hypotensive drugs fared better. It is recommended that patients suffering from primary hypertensive hemorrhage be treated with hypotensive drugs.

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