Blood Pressure in Acute Stroke To Treat or Not to Treat: That Is Still the Question

Are we EVER going to get a blood pressure protocol? Or will we wait until stroke survivors are in charge? This question has been out there forever. Is your doctor and stroke hospital still sitting on their asses WAITING FOR SOMEONE ELSE TO SOLVE THE PROBLEM? 

 Blood Pressure in Acute Stroke To Treat or Not to Treat: That Is Still the Question

Philip M. Bath, Jason P. Appleton, Kailash Krishnan, Nikola Sprigg

https://doi.org/10.1161/STROKEAHA.118.021254

Stroke. 2018;49:1784-1790

Originally published June 12, 2018

• Article
• Figures & Tables
• Supplemental Materials
• Info & Metrics

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

---

• acute stroke
• antihypertensive agent
• blood pressure
• hypertension
• intracerebral hemorrhage
• ischemic stroke

One of the oldest questions in acute stroke management, and perhaps the most challenging since it has yet to be solved after more than half a century of published research, is how to manage high blood pressure (BP). The problem might be summed up as follows:

To treat, or not to treat: that is the question:

Whether ’tis nobler in the mind to suffer

The slings and arrows of outrageous pressure,

Or to take drugs against a sea of blood,

And by opposing end them? To live: to walk;

—With apologies to Shakespeare, Hamlet Act III, Scene I

To treat, or not to treat, high BP was debated >30 years ago in 1985,^1–3 and yet there is no definitive answer here in 2018. Part of the debate is driven by opposing arguments based on epidemiology and pathophysiology and part by the failure of every large trial to provide a definitive answer. There is considerable evidence that high BP is associated independently with a poor outcome after ischemic stroke (IS) whether defined by early recurrence or death, or late death and dependency.^4,5 Similarly, high BP is related to hematoma expansion⁶ and functional outcome after intracerebral hemorrhage (ICH).⁷ A straightforward conclusion of this epidemiological evidence is that high BP should be lowered. In contrast, pathophysiological concerns are based on the presence of dysfunctional cerebral autoregulation during acute stroke, and so lowering BP will reduce tissue perfusion, increase lesion size, and thereby worsen outcome.⁸

There are many causes of high BP in acute stroke, including prior hypertension, acute neuroendocrine stimulation (via the renin-angiotensin-aldosterone system [RAAS], sympathetic autonomic nervous, and corticotrophin-cortisol systems), the Cushing reflex (due to raised intracranial pressure), and stress associated with admission to hospital and …

View Full Text

American Heart Association Professional?

Log in with your Professional Heart Daily username and password. Not an American Heart Association Professional? Continue below.

Log in using your username and password

Username *

Enter your Stroke username.

Password *

Enter the password that accompanies your username.

Forgot your user name or password?

Pay Per Article - You may access this article (from the computer you are currently using) for 1 day for US$35.00