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[Hypertension in the acute phase of cerebral infarction; not always to be treated]
1Afd. Inwendige Geneeskunde I, Academisch Ziekenhuis Rotterdam-Dijkzigt.
Insights
In acute cerebral infarction, high blood pressure often normalizes naturally. Lowering blood pressure may worsen the stroke, except in severe cases or with other heart conditions.
Area of Science:
- Neurology
- Cardiovascular Medicine
Context:
- Hypertension is prevalent in acute cerebral infarction patients.
- Elevated blood pressure typically self-resolves within days.
- High blood pressure may be a compensatory mechanism for cerebral perfusion.
Purpose:
- To review the evidence and arguments against treating hypertension in the acute phase of cerebral infarction.
- To identify specific clinical scenarios warranting antihypertensive treatment.
Summary:
- Spontaneous blood pressure reduction is common in acute stroke.
- Antihypertensive treatment could potentially expand infarction size.
- Limited evidence exists, but case reports suggest harm from acute blood pressure lowering.
- Exceptions include extremely high diastolic pressures or coexisting cardiovascular emergencies.
Impact:
- Discourages routine antihypertensive therapy in acute cerebral infarction.
- Highlights the potential risks of lowering blood pressure during stroke.
- Emphasizes careful patient selection for intervention in specific critical situations.
Abstract:
Hypertension is observed in three-fourths of the patients in the acute phase of a cerebral infarction. Treatment of an elevated blood pressure in the acute phase of a cerebral infarction is discouraged for the following arguments: In most instances the elevated blood pressure decreases spontaneously in the first few days after the infarction and stabilisation of the blood pressure is usually seen within 4 to 7 days. The elevated blood pressure in the acute phase of the cerebral infarction may be considered a favourable adaptation mechanism aimed at maintaining cerebral perfusion in the region surrounding the infarction. As a consequence lowering of the elevated blood pressure may be harmful because it can lead to expansion of the infarction. No controlled prospective studies to determine if treatment of hypertension in the acute phase of a cerebral infarction might be of benefit have been performed. There are, however, several case reports showing that treatment of an elevated blood pressure in the acute phase of a cerebral infarction is associated with dramatic progression of the neurological deficit. Exceptions can be made for situations where diastolic blood is repeatedly higher than 130-140 mmHg or where there are concomitant cardiovascular diseases, such as myocardial infarction, heart failure or a dissecting aneurysm requiring immediate antihypertensive treatment.