engleski

Treatement of elevated blood bressure in acute stroke

Elevated blood pressure (BP) is one of the most important stroke risk factors and there is no doubt about efficacy of lowering hypertension in order to prevent stroke. However elevated BP in onset of acute stroke is also very frequent and can be associated with stroke outcome. According to International Stroke Trial (IST) elevated BP is found in 75-80% patients in the first few hours after the stroke. Causes can be different: previously existing arterial hypertension, activation of neuroendocrine system, pain, nausea, vomiting, raised intracranial pressure, restlessness and disorientation, anxiety, stress caused by stroke, urinary bladder retention.... There is quite a controversy about association of elevated BP in acute stroke and stroke outcome. Stroke specialists face that dilemma on daily basis. In one hand elevated BP may be a compensatory mechanism of maintaining adequate brain perfusion, especially in disturbance of cerebral autoregulation and improve outcome of stroke, and on the other hand it can lead to increased fatal oedema or further vascular damage in patients with ischaemic stroke, or possible rebleeding in patients with brain hemorrhage, what is associated with poor outcome. Treatment of elevated BP in acute stroke is probably one of rare major clinical conditions with such lack of reliable data and studies. Present results are controversial. There is yet no scientific reason nor clinically proven benefit from the decrease of (not markedly) elevated BE Optimal treatment of elevated BP in acute stroke has not yet been established.

Acute stroke; high blood pressure; theraphy

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