Blood pressure control for acute severe ischemic and hemorrhagic stroke

被引:27
作者
Boesel, Julian [1 ]
机构
[1] Heidelberg Univ, Univ Heidelberg Hosp, Sect Acute & Crit Care Neurol, Dept Neurol, Neuenheimer Feld 400, D-69120 Heidelberg, Germany
关键词
acute hemorrhagic stroke; acute ischemic stroke; blood pressure; intracerebral hemorrhage; large-vessel occlusion; HEALTH-CARE PROFESSIONALS; INTRACEREBRAL HEMORRHAGE; ENDOVASCULAR TREATMENT; GENERAL-ANESTHESIA; CLINICAL-OUTCOMES; MANAGEMENT; THERAPY; HYPERTENSION; ASSOCIATION; VARIABILITY;
D O I
10.1097/MCC.0000000000000394
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Purpose of review Severe ischemic or hemorrhagic stroke is a devastating cerebrovascular disease often demanding critical care. Optimal management of blood pressure (BP) in the acute phase is controversial. The purpose of this review is to display insights from recent studies on BP control in both conditions. Recent findings BP control in acute ischemic stroke has recently been investigated with regard to endovascular recanalizing therapies. Decreases from baseline BP and hypotension during the intervention have been found detrimental. Overall, a periinterventional SBP between 140 and 160 mmHg appeared favorable in several studies. In acute hemorrhagic stroke, the recently completed Antihypertensive Treatment of Acute Cerebral Hemorrhage II trial confirmed feasibility of early aggressive BP reduction but failed to demonstrate a reduction in hematoma growth or a clinical benefit. Summary Recent findings do not support benefits of intensive BP lowering in both acute hemorrhagic and ischemic stroke, with the possible exception of the postinterventional phase after successful endovascular recanalization of large-vessel occlusions. Although optimal ranges of BP values remain to be defined, high BP should still be treated according to guidelines. As stroke patients requiring critical care are underrepresented in most studies on BP, caution in transferring these findings is warranted and prospective research in that patient population needed.
引用
收藏
页码:81 / 86
页数:6
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