Aggressive blood pressure control may worsen outcomes for stroke patients with poor kidney function

A new study warns that aggressive blood pressure control may harm stroke patients with poor kidney function. Researchers in Japan analysed data from a major US clinical trial and found that intensive treatment raised the risk of death or disability in these individuals. The findings highlight the need for tailored approaches when managing blood pressure after a brain bleed. The research, led by Kazunori Toyoda at Japan’s National Cerebral and Cardiovascular Center, examined patients from the ATACH-2 trial. This US-funded study had randomly assigned intracerebral hemorrhage patients to either intensive or standard blood pressure-lowering treatment for 24 hours. The primary goal was to measure death or severe disability rates after three months.

Patients were grouped by kidney function using their estimated glomerular filtration rate (eGFR) at admission. Those with reduced function (eGFR below 60) faced worse outcomes under intensive treatment. Nearly 50% of this group experienced death or disability, compared to about 32% of patients with normal kidney function. The study, published in *Neurology®*, suggests that excessive blood pressure reduction may be unsafe for patients with impaired kidneys. However, the authors note that the ideal target range for these individuals remains unclear and requires further investigation.

The findings underscore the importance of assessing kidney function before setting blood pressure targets in stroke care. Clinicians may now need to adjust treatment plans for patients with reduced eGFR to avoid unintended harm. More research is still needed to define the safest blood pressure range for this high-risk group.