Document Detail


Management of blood pressure after acute ischemic stroke: An evidence-based guide for the hospitalist.
MedLine Citation:
PMID:  17705177     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Hospitalists are frequently called upon to manage blood pressure after acute ischemic stroke. A review of both post infarction cerebral perfusion physiology and the data from randomized trials of antihypertensive therapy is necessary to explain why consensus guidelines for blood pressure management after stroke differ from those of other hypertensive emergencies. The peri-infarct penumbra is the central concept in understanding post ischemic cerebral perfusion. This area of impaired cerebral blood flow is dependent on mean arterial blood pressure and acute reduction of blood pressure may expand the area of infarction. Review of clinical trials fails to show benefit from reduction of blood pressure after ischemic stroke and current guidelines suggest antihypertensive therapy be employed if the systemic blood pressure is greater than 180/105 mmHg after tPA is employed, or 220/120 mmHg when tPA is not used. Induced hypertension remains a promising but unproven therapy in the acute setting, but the evidence for long term control of blood pressure to less than 140/80 mmHG for secondary prevention of stroke is strong. Adherence to guidelines is poor but it is recognized that current evidence is limited by a lack of trials in which blood pressure is titrated to a pre-specified goal, as is common in clinical practice.
Authors:
Ethan Cumbler; Jeffrey Glasheen
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of hospital medicine : an official publication of the Society of Hospital Medicine     Volume:  2     ISSN:  1553-5606     ISO Abbreviation:  J Hosp Med     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-09-24     Completed Date:  2007-10-18     Revised Date:  2010-06-30    
Medline Journal Info:
Nlm Unique ID:  101271025     Medline TA:  J Hosp Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  261-7     Citation Subset:  IM    
Copyright Information:
(c) 2007 Society of Hospital Medicine.
Affiliation:
Section of Hospital Medicine, Department of Internal Medicine, Division of General Internal Medicine, University of Colorado at Denver and Health Sciences Center, USA.
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MeSH Terms
Descriptor/Qualifier:
Antihypertensive Agents / therapeutic use
Blood Pressure / physiology*
Evidence-Based Medicine
Hospitalists*
Humans
Hypertension / complications,  prevention & control
Randomized Controlled Trials as Topic
Recurrence / prevention & control
Stroke / etiology,  physiopathology*,  prevention & control
Chemical
Reg. No./Substance:
0/Antihypertensive Agents

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


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