Blood pressure management

Depending upon the location and severity of the stroke at admission, patients may have cardiac and/or respiratory instability at the time of presentation to the emergency department (ED). They may need to be stabilized hemodynamically or intubated for airway protection or respiratory distress. Blood pressure management is often a crucial management issue, and the use of vasopressor or antihypertensive medications is common. In stroke patients at risk for malignant cerebral... 

Blood Pressure Management in the Setting of an Acute Cerebrovascular Accident... 

Lowering blood pressure in patients who are hypertensive has been shown to reduce the relative risk of stroke, both ischemic and hemorrhagic, by 35% to 45%.23 Also, the more blood pressure is lowered, the greater the reduction in stroke risk.24 All patients should have their blood pressure monitored and controlled appropriately based on current guidelines for blood pressure management. However, no one agent has been clearly shown to be more beneficial than any other for preventing stroke. 

Monamine oxidase inhibitors (MAOIs) (may impair blood pressure management and might also inhibit pseudocholinesterase)... 

Because time is of the essence, it is best if a stroke team that is trained specifically for the triage and treatment of acute stroke patients is formed and appropriate protocols are established. The MGH Acute Stroke Service protocols are listed in Tables 11.1-11.6. They include recommended time targets (Table 11.1) thrombolysis pretreatment phase procedures (Table 11.2) IV-t-PA treatment procedures including inclusion and exclusion criteria (Table 11.3) posttreatment procedures (Table 11.4) details of rt-PA infusion (Table 11.5) and guidelines for blood pressure management in patients receiving this treatment (Table 11.6). 

Optimizing cerebral perfusion, collateral circulation Appropriate blood pressure management Hyperthermia... 

Blood pressure in the early hours of stroke is above 160/90 mmHg in 80% of patients and generally normalizes without antihypertensive treatment in a majority of them (Oppenheimer and Hachinski, 1992 Phillips, 1994). Acute blood pressure management depends on whether thrombolytic therapy is being administered. 

Bosworth, H. B. et al.. Home blood pressure management and improved blood pressure control Results from a randomized controlled trial. Arch Intern Med Jul 11 171(13) 1173-1180,2011. 

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