Evidence review for maintenance of homeostasis: Stroke and transient ischaemic attack in over 16s: diagnosis and initial management

Excerpt

Elevated blood pressure is common after acute stroke. Patients may have pre-existing hypertension or blood pressure changes may occur as a result of disturbed cardiovascular autonomic regulation. Evidence has consistently shown that there is no benefit of lowering blood pressure acutely in ischaemic stroke however there is still clinical uncertainty regarding the safety and efficacy of lowering blood pressure in acute intracerebral haemorrhage. Uncontrolled hypertension in acute intracerebral haemorrhage may result in haemorrhagic expansion and a worse neurological outcome, however there is clinical concern that aggressive blood pressure lowering may reduce blood flow to the brain and other vital organs resulting in adverse outcomes such as cerebral and cord ischaemia, acute kidney injury, and myocardial infarction.

People with intracerebral haemorrhage have a mortality of around 40% with 60-70% of those who survive having moderate or severe disability and there are currently no treatment options beyond supportive management. If lowering blood pressure is safe and effective this may provide the opportunity improve the outcome in this type of stroke. As a number of clinical trials addressing the safety and efficacy of blood pressure lowering in acute intracerebral haemorrhage have been completed since the original guideline was published in 2008 it was important to review the current evidence regarding this clinical question.