Anne L Donovan1, Alana M Flexman, Adrian W Gelb. 1. Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California 94143-0648, USA.
Abstract
PURPOSE OF REVIEW: Cerebrovascular disease is a common cause of death and disability worldwide. The current literature supports an association between blood pressure (BP) and patient outcome during acute stroke. This review will provide an overview of the evidence to guide BP management during acute stroke. RECENT FINDINGS: Hypotension and hypertension are correlated with poor outcome in acute ischemic stroke, but the effect of reducing or augmenting BP is unclear. In most cases, BP should be treated only when SBP is greater than 220 or greater than 180 in candidates for thrombolysis. There is a lack of evidence to support the choice of specific agents. Use of vasopressor drugs to treat hypotension in acute stroke should be limited to selective situations. In acute hemorrhagic stroke, SBP greater than 140 has been correlated with poor outcomes. Two recent studies report the safety and feasibility of early BP reduction in hemorrhagic stroke. SUMMARY: Both hypertension and hypotension are associated with worse outcomes during acute stroke; however, the optimal hemodynamic parameters are not clearly defined in this patient population. Despite active research, there is a lack of high-quality data guiding current BP management in stroke. Several trials currently underway may clarify the many existing questions on this topic.
PURPOSE OF REVIEW: Cerebrovascular disease is a common cause of death and disability worldwide. The current literature supports an association between blood pressure (BP) and patient outcome during acute stroke. This review will provide an overview of the evidence to guide BP management during acute stroke. RECENT FINDINGS:Hypotension and hypertension are correlated with poor outcome in acute ischemic stroke, but the effect of reducing or augmenting BP is unclear. In most cases, BP should be treated only when SBP is greater than 220 or greater than 180 in candidates for thrombolysis. There is a lack of evidence to support the choice of specific agents. Use of vasopressor drugs to treat hypotension in acute stroke should be limited to selective situations. In acute hemorrhagic stroke, SBP greater than 140 has been correlated with poor outcomes. Two recent studies report the safety and feasibility of early BP reduction in hemorrhagic stroke. SUMMARY: Both hypertension and hypotension are associated with worse outcomes during acute stroke; however, the optimal hemodynamic parameters are not clearly defined in this patient population. Despite active research, there is a lack of high-quality data guiding current BP management in stroke. Several trials currently underway may clarify the many existing questions on this topic.
Authors: John Whittle; Alexander Nelson; James M Otto; Robert C M Stephens; Daniel S Martin; J Robert Sneyd; Richard Struthers; Gary Minto; Gareth L Ackland Journal: Open Heart Date: 2015-10-19