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(Hypertension. 2006;47:1051.)
© 2006 American Heart Association, Inc.

Editorial Commentaries

Treating Hypertension in Acute Stroke

A Better Arrow for the Quiver

From the Stroke Prevention and Atherosclerosis Research Centre, London, Ontario, Canada.

Correspondence to David Spence, Stroke Prevention and Atherosclerosis Research Centre, 1400 Western Rd, London, Ontario, Canada N6G 2V2. E-mail dspence@robarts.ca

An extract of the first 250 words of the full text is provided, because this article has no abstract.

There has been a longstanding controversy about whether high blood pressure should be treated in the setting of acute stroke.^1,2 Normally, cerebral blood flow is maintained through a wide range of systemic mean arterial blood pressure, from &50 to 150 mm Hg.^3,4 In the setting of cerebral ischemia (and probably also in the zone of injury around intracerebral hemorrhages), the ischemic zone partially loses autoregulation, so cerebral blood flow in that region becomes dependent on perfusion pressure.⁵ Many experts, therefore, recommended that blood pressure elevation, which is common in the setting of acute stroke, not be treated for fear of exacerbating stroke by reducing perfusion pressure and thereby reducing flow in the compromised but viable ischemic penumbra.

Because swelling in the region of ischemia raises tissue pressure, the cerebral perfusion pressure falls below systemic blood pressure, and it was thought that higher pressures might be beneficial. However, this is a double-edged sword, because pressures that are too high increase edema, leading to progressive infarction, causing tissue pressure to rise progressively, and reducing perfusion pressure farther and farther below systemic blood pressure. There is, therefore, a case for regulating blood pressure to an optimal level that maintains cerebral perfusion while minimizing exacerbation of edema. This may become possible through the recent development of methods to evaluate cerebral blood flow through widely available computerized tomography technology.⁶

Furthermore, as Del Maestro and I pointed out in 1985,² there are some circumstances in which the blood pressure must be treated, despite the occurrence of . . . [Full Text of this Article]

This article has been cited by other articles:

				J. D. Spence Treating Hypertension in Acute Ischemic Stroke Hypertension, October 1, 2009; 54(4): 702 - 703. [Full Text] [PDF]