Portal de Periódicos da CAPES

Blood Pressure Management in Acute Stroke

2006; Elsevier BV; Volume: 22; Issue: 4 Linguagem: Inglês

10.1016/j.ccc.2006.08.002

1557-8232

Victor Urrutia, Robert J. Wityk,

Traumatic Brain Injury and Neurovascular Disturbances

The optimal management of arterial blood pressure in the setting of an acute stroke has not been defined [ 1 Adams H. Adams R. Del Z.G. et al. Guidelines for the early management of patients with ischemic stroke: 2005 guidelines update: a scientific statement from the Stroke Council of the American Heart Association/American Stroke Association. Stroke. 2005; 36: 916-923 Crossref PubMed Scopus (383) Google Scholar , 2 Adams Jr., H.P. Adams R.J. Brott T. et al. Guidelines for the early management of patients with ischemic stroke: a scientific statement from the Stroke Council of the American Stroke Association. Stroke. 2003; 34: 1056-1083 Crossref PubMed Scopus (928) Google Scholar ]. Many reviews have been published on this topic in the past few years, but definitive evidence from clinical trials continues to be lacking [ 3 Markus H. Acute stroke. Int Psychogeriatr. 2003; 15: 161-166 Crossref PubMed Scopus (4) Google Scholar , 4 Goldstein L.B. Blood pressure management in patients with acute ischemic stroke. Hypertension. 2004; 43: 137-141 Crossref PubMed Scopus (38) Google Scholar , 5 Wityk R.J. Lewin III, J.J. Blood pressure management during acute ischaemic stroke. Expert Opin Pharmacother. 2006; 7: 247-258 Crossref PubMed Scopus (15) Google Scholar , 6 Bath P. High blood pressure as risk factor and prognostic predictor in acute ischaemic stroke: when and how to treat it?. Cerebrovasc Dis. 2004; 17: 51-57 Crossref PubMed Scopus (26) Google Scholar , 7 Verstappen A. Thijs V. What do we (not) know about the management of blood pressure in acute stroke?. Curr Neurol Neurosci Rep. 2004; 4: 505-509 Crossref PubMed Scopus (4) Google Scholar ]. This situation is complicated further because stroke is a heterogeneous disease. The best management of arterial blood pressure may be different depending on the type of stroke (ischemic or hemorrhagic) and among the subtypes of ischemic or hemorrhagic stroke [ 1 Adams H. Adams R. Del Z.G. et al. Guidelines for the early management of patients with ischemic stroke: 2005 guidelines update: a scientific statement from the Stroke Council of the American Heart Association/American Stroke Association. Stroke. 2005; 36: 916-923 Crossref PubMed Scopus (383) Google Scholar , 8 Broderick J.P. Adams Jr., H.P. Barsan W. et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 1999; 30: 905-915 Crossref PubMed Scopus (772) Google Scholar ]. This article reviews the relationship between arterial blood pressure and the pathophysiology specific to ischemic stroke, primary intracerebral hemorrhage (ICH), and aneurysmal subarachnoid hemorrhage (SAH), elaborating on the concept of ischemic penumbra and the role of cerebral autoregulation. The article also examines the impact of blood pressure and its management on outcome. Finally, an agenda for research in this field is outlined.