Hypertension in Acute Ischemic Strokes

Like the sea storm's pummeling effects in eroding a coastline, elevated blood pressures immediately after the onset of acute ischemic strokes might similarly be expected to batter impaired and vulnerable brain cells.¹,²But the issue of whether or not to lower elevated blood pressures acutely, an old debate, is not simply endothelial pounding; rather, the problem engages the crucial complexities of ensuring adequate blood flow to ischemically compromised tissue, the so-called ischemic penumbra³menacingly threatened by infarction. Justification and rationale for not treating hypertension in acute ischemic strokes to optimize blood flow are fourfold: (1) occurrence of altered autoregulation of cerebral blood flow in patients who were hypertensive prior to their stroke; (2) impaired autoregulation caused by strokes; (3) the hazards of inducing "watershed" infarction with hypotensive therapy; and (4) extension of ischemic damage in strokes that initially only partially occlude a major artery. 1. Chronic hypertension, the