Management of Hypertension in Patients With Acute Stroke

Lavin, Patrick

doi:10.1001/archinte.1986.00360130076011

Cited by 100 publications

(43 citation statements)

References 23 publications

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“…While appropriate in primary and secondary stroke prevention, the lowering of elevated blood pressure (BP) in the acute setting of ischemic stroke has been a matter of debate for several years. Some studies have suggested that it could result in the extension and worsening of stroke symptoms, resulting in unfavorable outcomes (8,22,40,45,55,56,78). In contrast, other experimental and clinical studies demonstrated that a cautious reduction of BP may even improve the prognosis in acute cerebral ischemia (24,45).…”

Section: Other Treatmentsmentioning

confidence: 99%

Stroke pathophysiology: management challenges and new treatment advances

Jordán

Ikuta

García-García

et al. 2007

J. Physiol. Biochem.

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J. JORDÁN, I. IKUTA, J. GARCÍA-GARCÍA, S. CALLEJA and T. SEGURA. Stroke pathophysiology: Management challenges and new treatment advances (minireview). J. Physiol. Biochem., 63 (3), 261-278, 2007. Stroke is the second leading cause of death and the first cause of lost disabilityadjusted years in developed countries. During the past decade, new developments in thrombolytic therapy have led to the implementation of emergency intervention protocols for the treatment of ischemic stroke, replacing the widespread sense of therapeutic nihilism in the past. Treatment with rtPA has shown to be effective within the first 3 hours following stroke onset and the FDA and the European Medical Agency (EMEA) have approved its use. Acknowledging the urgency and intricacies of stroke, Stroke Units allow the monitoring of physiological parameters in the acute phase of stroke and are considered an important management tool that can significantly improve the quality of care provided to the patient. The concept of neuroprotective therapy for acute ischemic stroke to salvage tissue at risk and improve functional outcome is based on sound scientific principles and extensive preclinical animal studies demonstrating efficacy. However, most neuroprotective drugs in clinical trials have failed, possibly due to inadequate preclinical testing or flawed clinical development programs. Several new treatment strategies are under development and are being tested. This review is directed at understanding the management of acute ischemic stroke pathophysiology. We address the management challenges and new treatment advances by integrating the knowledge of possible pharmacological targets for acute ischemic stroke. We hope to shed new light upon the controversy surrounding the management of acute ischemic stroke in an attempt to elucidate why failed clinical trials continue to occur despite promising neuroprotective preclinical studies.

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Section: Other Treatmentsmentioning

confidence: 99%

Stroke pathophysiology: management challenges and new treatment advances

Jordán

Ikuta

García-García

et al. 2007

J. Physiol. Biochem.

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“…Rapid blood pressure reduction could theoretically promote hypoperfusion and further ischaemia in the brain tissue surrounding the haematoma. 42,43 However, two recent prospective but small clinical studies 44,45 were unable to detect consistent evidence of an ischaemic tissue penumbra adjacent to the haematoma between 24-48 h after ICH. One study 45 of nine patients using magnetic resonance spectroscopic imaging had showed that only in the patient with the largest haematoma was there radiological evidence of ischaemia adjacent to the haematoma, although this was not confirmed by the presence of lactate, a metabolic marker of ischaemia.…”

Section: Considerations In Lowering Bp Early After Ichmentioning

confidence: 99%

“…Those with large ICH may have increased ICP associated with a secondary rise in systemic BP. 12,43 As cerebral arterial perfusion is a function of the difference between systemic arterial pressure and ICP, a fall in systemic BP may compromise cerebral perfusion. This problem may be exacerbated in patients with chronic hypertension.…”

Section: Considerations In Lowering Bp Early After Ichmentioning

confidence: 99%

Blood pressure in acute intracerebral haemorrhage

et al. 2004

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Stroke is one of the leading causes of death worldwide, and spontaneous bleeding into the brain parenchyma, intracerebral haemorrhage (ICH), is a stroke subtype associated with high morbidity and mortality. Overall, it comprises about 15% of all stroke in Caucasians, this figure being much higher in Asians and black people. Blood pressure (BP) appears to play an important role in this disease. We have reviewed available literature on the relationship of BP to the occurrence of primary and secondary ICH, the association of BP levels measured early after stroke with prognosis and complications, and evidence about the effects of early BP lowering treatments on post-stroke outcomes. BP appears to be an important risk factor for primary and secondary ICH. In addition, high BP early after ICH may be detrimental to outcome, possibly contributing to complications such as rebleeding and haematoma enlargement. Few data are available about the effects of early lowering of BP on outcome after ICH with no reliable trial yet conducted. Proper randomised trials are required to establish the effect of early lowering of BP on outcome after ICH.

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“…Management guidelines that have been proposed including JNC VI recommendations have been based on consensus statements rather than controlled trial evidence, and recommended treatment only for severe (180-220/110-120 mm Hg on repeated measurements) or complicated hypertension (cardiac failure or arterial dissection) after acute stroke. [12][13][14][15][16] The strikingly lower rate of haemorrhagic transformation within the National Institute of Neurological Disorders and Stroke rt-PA study 17 may be related to the exclusion of patients with uncontrolled hypertension, reinforcing the theoretical view that haemorrhagic transformation or cerebral oedema may be exacerbated by hypertension. This provides some rationale for BP control in the early hours or days after stroke which, taken with the evidence favouring long-term BP control, suggests that there may be an optimal time and degree of BP reduction that has yet to be established.…”

Section: Introductionmentioning

confidence: 99%

Prior antihypertensive treatment and admission blood pressure correlated with clinical outcome and early morning presentation in hypertensive ischaemic stroke patients

et al. 1999

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Blood pressure (BP) reduction of 5-6 mm Hg reduces the relative risk of stroke by 30-40%. This effect does not appear to depend on the antihypertensive agent used to bring about the required reduction in BP. Patients with acute ischaemic stroke often exhibit an elevated BP. These patients, who previously suffered from hypertension, have significantly higher levels of BP readings on admission with increased incidence of stroke immediately after arising. The aim of this study was to compare antihypertensive agents, especially short and long acting drugs with the measurement of BP on admission, the time of the ischaemic stroke and its clinical severity. This was studied retrospectively in 109 patients (55 females and 54 males). The mean age

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Management of Hypertension in Patients With Acute Stroke

Cited by 100 publications

References 23 publications

Stroke pathophysiology: management challenges and new treatment advances

Stroke pathophysiology: management challenges and new treatment advances

Blood pressure in acute intracerebral haemorrhage

Prior antihypertensive treatment and admission blood pressure correlated with clinical outcome and early morning presentation in hypertensive ischaemic stroke patients

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