Vaskulárna medicína 2/2014

Acute stroke and antihypertensive treatment

The acute hypertensive response occurs in more than 50% of all patients with acute stroke. However the treatment of hypertension in acute stroke is controversial, very high as well as low blood pressure have deleterious effect. In a consensus statement the American Heart Association and American Stroke Association has arbitrarily set for patients with hemorrhage stroke a systolic blood pressure of more than 200mmHg as target levels for aggressive management and more modest reduction when systolic blood pressure is more than 180mmHg. The blood pressure targets for patients with ischemic stroke eligible for thrombolytic therapy have been set at a systolic blood pressure less than 185mmHg and diastolic blood pressure less than 110mmHg and after use of reperfusion therapy systolic blood pressure less than 180mmHg and diastolic blood pressure less than 105 mmHg. For patients with ischemic stroke without reperfusion therapy the AHA/ASA has set systolic blood pressure over 220 mmHg or diastolic blood pressure over 120 mmHg as a target of therapy. Within the first hour blood pressure decline cannot exceed 20%, as a optimal decline is considered 10%. Fast but short acting intravenous (IV) antihypertensive drugs are preferred for the accurate titration of the effect. IV antihypertensive drugs with side effect of steal phenomenon, worsening of brain oedema or intracranial hypertension are to be excluded.

Keywords: acute stroke, antihypertensive treatment, blood pressure targets.