Blood pressure management in acute stroke

Appleton, Jason P.; Sprigg, Nikola; Bath, Philip M.W.

Abstract

Blood pressure (BP) is elevated in 75% or more of patients with acute stroke and is associated with poor outcomes. Whether to modulate BP in acute stroke has long been debated. With the loss of normal cerebral autoregulation, theoretical concerns are twofold: high BP can lead to cerebral oedema, haematoma expansion or haemorrhagic transformation; and low BP can lead to increased cerebral infarction or perihaematomal ischaemia. Published evidence from multiple large, high-quality, randomised trials is increasing our understanding of this challenging area, such that BP lowering is recommended in acute intracerebral haemorrhage and is safe in ischaemic stroke. Here we review the evidence for BP modulation in acute stroke, discuss the issues raised and look to on-going and future research to identify patient subgroups who are most likely to benefit.

Citation

Appleton, J. P., Sprigg, N., & Bath, P. M. (in press). Blood pressure management in acute stroke. Stroke and Vascular Neurology, 1(2), https://doi.org/10.1136/svn-2016-000020

• Journal Article Type: Article
• Acceptance Date: May 20, 2016
• Online Publication Date: Jun 24, 2016
• Deposit Date: Jul 18, 2016
• Publicly Available Date: Jul 18, 2016
• Journal: Stroke and Vascular Neurology
• Electronic ISSN: 2059-8696
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 1
• Issue: 2
• DOI: https://doi.org/10.1136/svn-2016-000020
• Public URL: https://nottingham-repository.worktribe.com/output/793629
• Publisher URL: http://svn.bmj.com/content/1/2/72