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Paul S. Slosberg, MD

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This most interesting article by Martin-Schild et al¹ raises what I believe is a crucial question, viz, what is the best, safest level of blood pressure (BP) to be sought in its reduction? That is, what degree of reduction will decrease the risk of hemorrhage while ensuring brain perfusion that is as adequate as possible? In this regard, I had introduced BP reduction (hypotensive therapy) for acute intracranial bleeding in 1956²; the original 4 cases had included 3 with proven aneurysms, 1 of which also had a probable intracerebral hemorrhage. Subsequently to determine the best, safest degree of BP reduction, a titration method was developed based on carefully monitored, induced cerebrovascular insufficiency for cases of subarachnoid hemorrhage due to ruptured brain aneurysms—this problem was deemed the more urgent one owing to the possibility of devastating recurrent hemorrhage as opposed to the initial problem of intracerebral . . . [Full Text of this Article]

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