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In favour of lewering EP “Against lowering BP Longer term benefits of BP lowering are proven (Quicomes poorar in acute stroke hypertension High BP has increased incidence of haemorrhagic transformation May allow for IV’ thrombolysis: 7 Arguments for and against coute Seer eet erent nin ry Acute BP changes often transient Large changes in BP associated with poor outcomes Lose of autoregulation-cerabral blood flow depends on systemic pressure If vascular stenosis, high pressure may be needed for tissue perfusion Certain agents harmful in acute stroke 7 Figure 1. Potential risks and benefits of intervening to lower blood pressu BP: Blood pressure hypertensive acute stroke patients. Blood pressure Days from ictus os ar ray ‘Continue usual Init >E2ON20 | tinyperiensives antihypertensive {ADE +thiazide) IF end organ damage ‘OR thrombolysis candidate| ‘consider: IV therapy Avoid Recammence usual | | Inti 180110 i antinypertensives antinypertensives cantihypertansives =“ i (ACE +/hiazice) ‘Avoid ecommence usual aon antihypertensive anihypertansives ‘More aggressive treatment Lees aggressive treatment Diabetes Melitus Advanced age Periventricular ow attenuation ‘Severe Carobd/Basiar disease ‘Anticoagulation ‘Watershed infarction Elighle for thrombolysis Previous hypertension Possible intracerebralhemorrhge Figure 2. Pragmatic approach to the hypertensive acute stroke patient. Consideration of the absolute blood pressure, end organ damage, time from stroke onset, etiology of stroke (ischemic, hemorrhagic, watershed), elighilty for thrombolysis ‘and pre-existing or concomitant comorbidities (e.g. clabetes, hypertension anticoagulation) places the patient. within a ‘hypertensive stroke patient matrix’ requiring tailored treatment. ACE: Angiotensin-corwerting enzyme. Initial measures: ‘observe and allow to settle “Treat any comorbidities or complications (sepsis, pain, anxiety etc) ‘+ Review pre-admission anti-hypertensive therapy: + Avoidcalcium channel-and beta-blockers if possible + Rlapeat or double dase every 40min (max 200mg single dose) Tanger: 10-15% reduction in BP + Iv GTN (EO syringer initially Img (1m) per hour 3. Practical clinical approach to treatment of hypertension in scute stroke. Rly 05-15 pykgrmn (adisted a steps of OS vain every rinsing or ee ‘ACE: angiotensin-converting enzyme inhibitor; ARB: angiotensin II receptor biocker; hemorrhage: BP: bleod pressure: GTM ysl trina; ICH: intracerebral IV: intravenous; NG: nasogastric.