Sunday, July 16, 2017

Elevated blood pressure in the setting of acute ischemic stroke needs to be judiciously treated because:



Elevated blood pressure in the setting of acute ischemic stroke needs to be judiciously treated because:

A. High blood pressure needs to be treated aggressively in order to decrease the incidence of intracranial bleeding.
B. Acute elevations in blood pressure usually do not spontaneously decline.
C. Blood pressures above 160 mmHg systolic or 100 mmHg diastolic are immediately life-threatening.
D. Areas of ischemic brain lose autoregulation and may be dependent on elevated mean arterial pressure to maintain perfusion.
E. Aggressive lowering of blood pressure with acute ischemic stroke improves outcome.

Answer : D. Areas of ischemic brain lose autoregulation and may be dependent on elevated mean arterial pressure to maintain perfusion.

Discussion: In an acute ischemic stroke, some neurons die within a few minutes of complete loss of their blood supply. Other surrounding areas have relative ischemia and are at risk for cell death if blood flow is not maintained or improved. These areas may be dependent on a short-term elevation of the mean arterial pressure in order to maintain adequate perfusion for survival. In general, unless systolic blood pressure remains above 220 mmHg or diastolic pressure remains above 120 mmHg, elevated blood pressure should not be treated within the first 48 to 72 hours after an acute ischemic stroke. Multiple trials have shown that more aggressive management of blood pressure in the setting of acute ischemic stroke is associated with worse outcomes.

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