Document Detail


Blood pressure control for acute ischemic and hemorrhagic stroke.
MedLine Citation:
PMID:  22322257     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: 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.
RECENT FINDINGS: 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.
SUMMARY: 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.
Authors:
Erin M Grise; Opeolu Adeoye
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in critical care     Volume:  18     ISSN:  1531-7072     ISO Abbreviation:  Curr Opin Crit Care     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-03-07     Completed Date:  2012-06-25     Revised Date:  2014-04-08    
Medline Journal Info:
Nlm Unique ID:  9504454     Medline TA:  Curr Opin Crit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  132-8     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Antihypertensive Agents / therapeutic use*
Blood Pressure / drug effects*
Blood Pressure Determination
Cerebral Hemorrhage / complications*,  mortality,  physiopathology
Female
Guidelines as Topic
Humans
Hypertension / drug therapy*,  etiology
Hypotension / etiology
Male
Stroke / complications*,  mortality,  physiopathology
Subarachnoid Hemorrhage / complications*,  physiopathology
Treatment Outcome
Grant Support
ID/Acronym/Agency:
UL1 TR000077/TR/NCATS NIH HHS
Chemical
Reg. No./Substance:
0/Antihypertensive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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