Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 May 7;23(6):63.
doi: 10.1007/s11886-021-01497-0.

Impact of Early Blood Pressure Lowering in Patients Presenting with Acute Ischemic Stroke

A Maud  1 , G J Rodriguez  2 , A Vellipuram  2 , F Sheriff  2 , M Ghatali  2 , V Gupta  2 , R Khatri  2 , S Cruz-Flores  2
Affiliations
Review

Impact of Early Blood Pressure Lowering in Patients Presenting with Acute Ischemic Stroke

A Maud et al. Curr Cardiol Rep. .

Abstract

Purpose of review: In this review article we will discuss the acute hypertensive response in the context of acute ischemic stroke and present the latest evidence-based concepts of the significance and management of the hemodynamic response in acute ischemic stroke.

Recent findings: Acute hypertensive response is considered a common hemodynamic physiologic response in the early setting of an acute ischemic stroke. The significance of the acute hypertensive response is not entirely well understood. However, in certain types of acute ischemic strokes, the systemic elevation of the blood pressure helps to maintain the collateral blood flow in the penumbral ischemic tissue. The magnitude of the elevation of the systemic blood pressure that contributes to the maintenance of the collateral flow is not well established. The overcorrection of this physiologic hemodynamic response before an effective vessel recanalization takes place can carry a negative impact in the final clinical outcome. The significance of the persistence of the acute hypertensive response after an effective vessel recanalization is poorly understood, and it may negatively affect the final outcome due to reperfusion injury. Acute hypertensive response is considered a common hemodynamic reaction of the cardiovascular system in the context of an acute ischemic stroke. The reaction is particularly common in acute brain embolic occlusion of large intracranial vessels. Its early management before, during, and immediately after arterial reperfusion has a repercussion in the final fate of the ischemic tissue and the clinical outcome.

Keywords: Acute ischemic stroke; Blood pressure; Cerebrovascular disease.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Panel a Lateral view from digital subtraction angiography of the brain showing an acute embolic occlusion of the right internal carotid artery terminus corresponding to a thrombolysis in cerebral ischemia score of zero. Panel b Lateral view from digital subtraction angiography of the brain showing complete recanalization after mechanical thrombectomy corresponding to a thrombolysis in cerebral ischemia score of three
Fig. 2
Fig. 2
Algorithm for intervention in the acute hypertensive response in patients presenting with acute ischemic stroke considered for acute reperfusion therapies. Cautious and stepwise blood pressure reduction (no more than 20% if the baseline MAP) is advised. Placement of arterial line for continuous real time blood pressure monitoring is suggested. Intravenous bolus and intravenous infusion of short-acting vasodilators is recommended. *If mechanical thrombectomy is performed concomitant to IV rt-PA infusion then the blood pressure parameters for intravenous thrombolysis should be followed. **Consider history of premorbid arterial hypertension and baseline systolic and diastolic blood pressure
See this image and copyright information in PMC

References

    1. Robinson TG, Potter JF. Blood pressure in acute stroke. Age Ageing. 2004;33(1):6–12. doi: 10.1093/ageing/afg121. - DOI - PubMed
    1. Cersosimo MG, Benarroch EE. Central control of autonomic function and involvement in neurodegenerative disorders. Handb Clin Neurol. 2013;117:45–57. doi: 10.1016/B978-0-444-53491-0.00005-5. - DOI - PubMed
    1. Wehrwein EA, Joyner MJ. Regulation of blood pressure by the arterial baroreflex and autonomic nervous system. Handb Clin Neurol. 2013;117:89–102. doi: 10.1016/B978-0-444-53491-0.00008-0. - DOI - PubMed
    1. Benarroch EE. Physiology and pathophysiology of the autonomic nervous system. Continuum (Minneap Minn) 2020;26(1):12–24. - PubMed
    1. Qureshi AI, Palesch YY, Barsan WG, Hanley DF, Hsu CY, Martin RL, Moy CS, Silbergleit R, Steiner T, Suarez JI, Toyoda K, Wang Y, Yamamoto H, Yoon BW, ATACH-2 Trial Investigators and the Neurological Emergency Treatment Trials Network Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med. 2016;375(11):1033–1043. doi: 10.1056/NEJMoa1603460. - DOI - PMC - PubMed