Successful managing Long term blood pressure control in complicated cerebral hemorrhage with renal failure: a survival case report

Introduction: Hypertensive emergencies in acute kidney failure can cause severe damage to internal organs, including recurrent ICH and cardiovascular disease (CVD). Effective blood pressure control is crucial for reducing these risks. We present herein a case of A spontaneous ICH patient successfully passed the critical phase. Case Ilustration: A 49-year-old man experienced sudden unconsciousness while at home due to poorly controlled chronic hypertension. He had a history of CKD, DM, and atrial fibrillation. The patient had 215/121 mmHg blood pressure, right hemiparesis, irregular heart rate, high ureum and creatinine. The Head CT scan Showed Multiple sites cerebral Hemorrhage. Treatment included continuous intravenous Nicardipin and Amiodarone, with hemodyalization 2-3 times a week and Emergency External ventricular drainage was placed to manage the intracranial pressure. Oral anti hypertensions Candesartan 1x16 mg, Adalat oros 1x30 mg and 2.5 mg Bisoprolol were added. The patient’s blood pressure improved, but the GCS remained unimproved. After four weeks discharged, the patient had clear speech and could independently mobilize without assistance. Discussion: Cerebral autoregulation maintains cerebral blood flow. Aggressive management of acute hypertension in ICH is still controversial. In the long-term, oral antihypertensive drugs should be titrated as soon as possible to achieve a goal BP <130/80 mm Hg Result: The choice of BP-lowering agents is crucial for optimizing risk reduction, with thiazide-type diuretics, calcium channel blockers, ACE inhibitors, or angiotensin receptor blockers being the main therapy. Conclusion: Managing BP control from hyperacute to chronic stages will be essential for the better recovery of patients after ICH.