Blood pressure management during acute ischaemic stroke.
Control of hypertension is a well-established goal of primary stroke prevention. Management of blood pressure in patients during acute ischaemic stroke, however, is complicated by the need to maintain brain perfusion. Lowering blood pressure in the acute setting may avoid the deleterious effects of high blood pressure but may also lead to cerebral hypoperfusion and worsening of the ischaemic stroke. Little information is available from clinical trials concerning optimal blood pressure management in acute stroke. Current protocols of thrombolytic therapy require strict blood pressure control below certain prescribed limits; however, in most acute stroke patients not treated with thrombolysis, blood pressure reduction is not routinely recommended and guidelines for target blood pressures are difficult to justify. Preliminary studies, in fact, suggest that there may be a role for blood pressure elevation in the treatment of some patients with acute ischaemic stroke.
Wityk
Robert J
RJ
Cerebrovascular Division, The Johns Hopkins Hospital, Phipps 126 B, Baltimore, MD 21287, USA. rwityk@jhmi.edu
Lewin
John J
JJ
D018674:Adrenergic Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D000316:Adrenergic alpha-Agonists / Q000494:pharmacology / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000494:pharmacology / Q000627:therapeutic use; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D000818:Animals; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002545:Brain Ischemia / Q000188:drug therapy* / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000188:drug therapy / Q000503:physiopathology; D004353:Drug Evaluation, Preclinical; D005343:Fibrinolytic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000188:drug therapy* / Q000503:physiopathology; D013566:Sympathomimetics / Q000494:pharmacology / Q000627:therapeutic use*; D015912:Thrombolytic Therapy
D018674:Adrenergic Antagonists; D000316:Adrenergic alpha-Agonists; D000318:Adrenergic beta-Agonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents; D013566:Sympathomimetics