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Blood pressure control for acute severe ischemic and hemorrhagic stroke

Bösel, Julian

Current Opinion in Critical Care: April 2017 - Volume 23 - Issue 2 - p 81–86
doi: 10.1097/MCC.0000000000000394
NEUROSCIENCE: Edited by Raimund Helbok
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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.

Section of Acute and Critical Care Neurology, Department of Neurology, Heidelberg University Hospital, University of Heidelberg, Heidelberg, Germany

Correspondence to Julian Bösel, MD, FNCS, Director, Section of Acute and Critical Care Neurology, Department of Neurology, Heidelberg University Hospital, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany. E-mail: julian.boesel@med.uni-heidelberg.de

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