The challenge of blood pressure management in neurologic emergencies.
Hypertensive crises are commonly seen in the emergency department, and acute stroke is often the inciting etiology of a hypertensive crisis. Cerebral autoregulation is disrupted in acute stroke, and efforts to lower blood pressure may reduce cerebral perfusion and worsen outcomes. Although most patients with stroke have elevated blood pressure, evidence from clinical trials to guide therapy are scarce. Current national guidelines recommend lowering blood pressure after stroke only if end-organ damage is present or if systolic/diastolic blood pressures exceed 220/120 or 185/110 mm Hg in patients ineligible and in those eligible to receive thrombolytic drug therapy, respectively. Recommended pharmacologic interventions for elevated blood pressure after acute ischemic stroke include labetalol, nicardipine, or nitroprusside, depending on the severity of the elevation. Similar recommendations have been made for intracerebral hemorrhage. Subarachnoid hemorrhage is managed with nimodipine and other calcium channel blockers to prevent vasospasm and improve clinical outcomes. Data from ongoing clinical trials may improve guidance about the management of elevated blood pressure after acute stroke.
Talbert
Robert L
RL
College of Pharmacy, University of Texas at Austin, Austin, Texas, USA. talbert@uthscsa.edu
D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000150:complications / Q000188:drug therapy; D002560:Cerebrovascular Circulation / Q000187:drug effects; D004638:Emergency Treatment; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D002546:Ischemic Attack, Transient / Q000150:complications / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000188:drug therapy; D014665:Vasodilator Agents / Q000627:therapeutic use; D020301:Vasospasm, Intracranial / Q000150:complications / Q000188:drug therapy
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D014665:Vasodilator Agents