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Vol 56, No 2 (2022)
Review Article
Submitted: 2021-06-03
Accepted: 2021-08-02
Published online: 2021-10-08
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Ambiguities in blood pressure management in acute ischaemic stroke

Maria Kamieniarz-Mędrygał1, Radosław Kaźmierski23
DOI: 10.5603/PJNNS.a2021.0064
·
Pubmed: 34622935
·
Neurol Neurochir Pol 2022;56(2):131-140.
Affiliations
  1. Department of Neurology, S. T. Dąbrowski Hospital in Puszczykowo, Poland
  2. Department of Neurology and Cerebrovascular Disorders, Poznan University of Medical Sciences, Poznan, Poland
  3. Department of Neurology, University of Zielona Gora, Zielona Gora, Poland

open access

Vol 56, No 2 (2022)
Review articles
Submitted: 2021-06-03
Accepted: 2021-08-02
Published online: 2021-10-08

Abstract

Introduction: Blood pressure management in acute ischaemic stroke is crucial. Here we highlight uncertainties surrounding haemodynamic management in acute ischaemic stroke on the basis of current guidelines and the data available from recent studies. This review provides practical treatment options and suggestions for future research.

State of the art: The U-shaped relationship between baseline blood pressure value and patients’ functional outcome or death is well established. Nonetheless, there is scant evidence for the benefits of early pharmacological intervention. Current guidelines differentiate blood pressure targets on the basis of implemented reperfusion treatment and allow blood pressure reduction in certain clinical situations. However, there is a substantial lack of evidence to guide management during acute stroke.

Clinical implications: Taking into account several aspects of blood pressure management can improve stroke care, although they are not included in current guidelines. To make an optimal decision as to whether to intervene regarding blood pressure, it is important to consider dehydration, recanalisation status, blood pressure variability, and autoregulation state as measured by novel imaging techniques.

Future directions: Further trials considering patient-specific factors with the use of continuous monitoring of blood pressure, as well as neurovascular imaging, are needed to resolve the current ambiguities.

Abstract

Introduction: Blood pressure management in acute ischaemic stroke is crucial. Here we highlight uncertainties surrounding haemodynamic management in acute ischaemic stroke on the basis of current guidelines and the data available from recent studies. This review provides practical treatment options and suggestions for future research.

State of the art: The U-shaped relationship between baseline blood pressure value and patients’ functional outcome or death is well established. Nonetheless, there is scant evidence for the benefits of early pharmacological intervention. Current guidelines differentiate blood pressure targets on the basis of implemented reperfusion treatment and allow blood pressure reduction in certain clinical situations. However, there is a substantial lack of evidence to guide management during acute stroke.

Clinical implications: Taking into account several aspects of blood pressure management can improve stroke care, although they are not included in current guidelines. To make an optimal decision as to whether to intervene regarding blood pressure, it is important to consider dehydration, recanalisation status, blood pressure variability, and autoregulation state as measured by novel imaging techniques.

Future directions: Further trials considering patient-specific factors with the use of continuous monitoring of blood pressure, as well as neurovascular imaging, are needed to resolve the current ambiguities.

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Keywords

blood pressure, ischaemic stroke, acute management, revascularisation

About this article
Title

Ambiguities in blood pressure management in acute ischaemic stroke

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 56, No 2 (2022)

Article type

Review Article

Pages

131-140

Published online

2021-10-08

Page views

5422

Article views/downloads

914

DOI

10.5603/PJNNS.a2021.0064

Pubmed

34622935

Bibliographic record

Neurol Neurochir Pol 2022;56(2):131-140.

Keywords

blood pressure
ischaemic stroke
acute management
revascularisation

Authors

Maria Kamieniarz-Mędrygał
Radosław Kaźmierski

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