In acute intracerebral hemorrhage, lowering BP is to minimize hematoma expansion while maintaining cerebral perfusion.

• A. Minimize hematoma expansion while maintaining cerebral perfusion
• B. Normalize BP to 120/80 immediately
• C. Increase perfusion by raising BP
• D. No effect on hematoma

Answer: (A)

In acute intracerebral hemorrhage the goal is to limit further bleeding while keeping enough blood flow to the brain. Lowering blood pressure helps reduce the pressure driving ongoing bleeding, which can limit hematoma expansion. At the same time, you don’t want to drop the pressure so much that the brain doesn’t get enough blood—and worsens injury around the hematoma. So the best approach is to minimize hematoma expansion while preserving cerebral perfusion.

Normalizing to a very low target like 120/80 immediately can be unsafe because it risks cerebral hypoperfusion, especially if intracranial pressure is high or autoregulation is impaired. Increasing BP to raise perfusion would likely worsen the bleed. Saying there’s no effect on hematoma ignores the relationship between blood pressure and bleeding risk.