Karen O Appiah1, Jatinder S Minhas1, Thompson G Robinson1,2. 1. Department of Cardiovascular Sciences, University of Leicester, The Glenfield Hospital, British Heart Foundation Cardiovascular Research Centre. 2. NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.
Abstract
PURPOSE OF REVIEW: Blood pressure (BP) elevations above premorbid levels are observed in at least 60% of acute ischemic and hemorrhagic stroke patients, within the first 24 h of symptom onset. A number of potential causes have been hypothesized, and high BP may be associated with poor stroke outcome. This review discusses management strategies of high BP in acute stroke, in the context of current guidelines. RECENT FINDINGS: Excessive BP elevation can impact acute stroke therapeutic strategies, particularly in modifying intervention safety and efficacy. Currently, guidance on BP management in acute ischemic stroke and intracerebral hemorrhage (ICH) exists in a limited number of specific clinical presentations, including spontaneous ICH and continuing versus stopping preexisting antihypertensive therapy. However, ongoing clinical trials will further investigate the safety and efficacy of urgent BP-lowering therapy for other indications. SUMMARY: There are clear national and international guidelines on BP lowering for specific indications, as well as ongoing clinical trials aiming to address common clinical scenarios in which the evidence-base is lacking and uncertain. This is specifically in important stroke subgroups previously excluded from trials, patients requiring mechanical thrombectomy and nonvitamin K antagonist-associated ICH reversal.
PURPOSE OF REVIEW: Blood pressure (BP) elevations above premorbid levels are observed in at least 60% of acute ischemic and hemorrhagic stroke patients, within the first 24 h of symptom onset. A number of potential causes have been hypothesized, and high BP may be associated with poor stroke outcome. This review discusses management strategies of high BP in acute stroke, in the context of current guidelines. RECENT FINDINGS: Excessive BP elevation can impact acute stroke therapeutic strategies, particularly in modifying intervention safety and efficacy. Currently, guidance on BP management in acute ischemic stroke and intracerebral hemorrhage (ICH) exists in a limited number of specific clinical presentations, including spontaneous ICH and continuing versus stopping preexisting antihypertensive therapy. However, ongoing clinical trials will further investigate the safety and efficacy of urgent BP-lowering therapy for other indications. SUMMARY: There are clear national and international guidelines on BP lowering for specific indications, as well as ongoing clinical trials aiming to address common clinical scenarios in which the evidence-base is lacking and uncertain. This is specifically in important stroke subgroups previously excluded from trials, patients requiring mechanical thrombectomy and nonvitamin K antagonist-associated ICH reversal.
Authors: Jatinder S Minhas; Xia Wang; Pablo M Lavados; Tom J Moullaali; Hisatomi Arima; Laurent Billot; Maree L Hackett; Veronica V Olavarria; Sandy Middleton; Octavio Pontes-Neto; H Asita De Silva; Tsong-Hai Lee; Jeyaraj D Pandian; Gillian E Mead; Caroline Watkins; John Chalmers; Craig S Anderson; Thompson G Robinson Journal: J Hum Hypertens Date: 2019-03-20 Impact factor: 3.012