Blood pressure control for acute ischemic and hemorrhagic stroke.
OBJECTIVE
Acute stroke, including the subtypes of ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH), typically involves significant fluctuations in blood pressure (BP). Treatment of BP after all stroke types is controversial. In each case, there are theoretical dangers to leaving BP alone as well as altering it artificially. In this article, we review the role of BP in each stroke subtype and the existing evidence for BP optimization.


RESULTS
Except in patients receiving thrombolytic therapy, there is insufficient evidence to recommend active BP management in ischemic stroke. In ICH, the Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) trial and Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT) have demonstrated that systolic BP reduction to 140  mmHg is well tolerated and associated with attenuation of hematoma expansion. The impact of BP reduction on outcomes is being evaluated in the ongoing phase III ATACH II and INTERACT 2 trials. No evidence exists to recommend definitive BP management strategies in acute SAH, although hypertension should likely be avoided before an aneurysm is secured, and hypotension should be avoided altogether.


CONCLUSIONS
Evidence for BP management in acute stroke is limited, although large randomized trials are currently in progress for both ischemic stroke and ICH. BP management in SAH remains woefully understudied.
Department of Emergency Medicine and Division of Neurocritical Care, Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0769, USA.
Erin M
EM
Grise
Opeolu
O
Adeoye
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D007022:Hypotension / Q000209:etiology; D008297:Male; D020521:Stroke / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000503:physiopathology; D016896:Treatment Outcome
D000959:Antihypertensive Agents