Blood pressure control for acute ischemic and hemorrhagic stroke

Current Opinion in Critical Care, 03/26/2012

Evidence for BP management in acute stroke is limited, although large randomized trials are currently in progress for both ischemic stroke and intracerebral hemorrhage (ICH). Blood pressure management in subarachnoid hemorrhage remains woefully understudied.

  • 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 140mmHg 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.

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