The Management of Hypertension for an Acute Stroke: What Is the Blood Pressure Goal?
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Stroke is the 4th leading cause of death in the US and a leading cause of disability among adults. Stroke is broadly classified into ischemic and hemorrhagic subtypes. Although the pathogenesis may differ between ischemic and hemorrhagic stroke subtypes, a unifying feature is that hypertension is a major risk factor for most ischemic and hemorrhagic strokes. Prevention of first and recurrent stroke is substantially dependent on blood pressure control. There is controversy about blood pressure management in acute stroke. In this review we discuss controversies about and guidelines for management of blood pressure in acute stroke. We subdivide our discussion to address important questions about acute blood pressure management in ischemic stroke, intraparenchymal hemorrhage, and subarachnoid hemorrhage. In addition, we address BP control recommendations when tissue plasminogen activator administration is being contemplated for treatment of acute ischemic stroke.
KeywordsBlood pressure Hypertension Acute stroke Ischemic stroke Hemorrhagic stroke Mean arterial pressure Guidelines
Conflict of Interest
Philip B. Gorelick has received grant support from H. Lundbeck as the Co-Director of Clinical Coordinating Center for US DIAS 4 Trial (desmoteplase in acute ischemic stroke); has received honoraria from both Brainsgate and DPharm, on which he is a Steering Committee Member; and he has received payment for development of educational presentations including service on speakers' bureaus from the American Academy of Neurology.
Venkatesh Aiyagari has received grant support from the World Federation of Neurology and World Stroke Association; and has received royalty from Springer for co-editing a monograph on stroke and hypertension.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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