While antihypertensive therapy is effective for stroke prevention, aggressive blood pressure lowering in acute stroke or vulnerable patients carries significant risks of cerebral ischemia.
May warrant caution against overzealous BP lowering in acute stroke or frail elderly; leaves open optimal thresholds for RCTs.
Antihypertensive treatment effectively prevents haemorrhagic and lacunar stroke, and apparently also transient ischaemic attacks. It is likely that treatment also affords some protection against other thrombotic strokes. Acute stroke is often associated with a transient rise in blood pressure, which may be superimposed on a chronic hypertensive state. Emergency treatment of hypertension should probably only be given to the most extremely elevated pressures in acute stroke. In the occasional patient, overzealous antihypertensive treatment may cause cerebral ischaemia or even ischaemic stroke. Aside from acute stroke with transient hypertension, the risk of overtreatment is most marked in very severe hypertension, in the frail elderly hypertensive with postural hypertension, and in the rare cases of haemodynamically mediated transient ischaemic attacks. (Hypertens Res 1994; 17 Suppl.
No takes yet. Share an insight, caveat, or question.
Svend Strandgaard (1994) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: