Problems Related to Short-Term Antihypertensive Therapy in Acute Ischemic Stroke

Abstract

Hypertension is a common early finding after an acute ischemic stroke, even in previously normotensive patients. But its significance and proper management are a matter of debate, because of the lack of adequately powered randomized clinical trials. A close analysis of observational and interventional trials, published so far, fails to convince that an early antihypertensive therapy is needed and beneficial. During the first 24-48 hr after ischemic stroke, only blood pressure values repeatedly higher than 220/120 mmHg require antihypertensive treatment to keep blood pressure levels in the range of 180-220 mmHg systolic and 100-120 diastolic. Blood pressure reduction should be cautious with the aim of keeping the pressure at relatively high values (180/100-105 in previously hypertensive patients and 160-180/90-100 in previously normotensive patients). The usefulness of increasing blood pressure with vasopressive agents in selected patients with ischemic stroke deserves adequate testing with randomized clinical trials.

A Sartan Derivative with a Very Low Angiotensin II Receptor Affinity Ameliorates Ischemic Cerebral Damage

“…Extended clinical trials are required before any advocation of R-147176 use in cerebral disorders. R-147176's advantage over ARBs lies in its absence of hypotensive effect in patients with a normal or even low blood pressure: it should prevent any aggravation of acute ischemia in the penumbral region (Yatsu and Zinvin, 1985; Fischberg et al , 2000; Castillo et al , 2004; Semplicini et al , 2006; Wityk and Lewin, 2006). This drug is safe in the acute and subacute toxicity studies (Izuhara et al , 2008 b ).…”

A Novel Sartan Derivative With Very Low Angiotensin II Type 1 Receptor Affinity Protects the Kidney in Type 2 Diabetic Rats

“…An ARBinduced blood pressure reduction occasionally decreases cerebral blood supply to the penumbral region, impacting on mortality and disabling long-term morbidity. [23][24][25][26] R-147176 should thus expand our therapeutic options in the treatment of cardiovascular and kidney diseases.…”

Trombólise intra-arterial e controle da hipotensão em acidente vascular cerebral

“…O controle da pressão arterial sistêmica (PA) na fase aguda do acidente vascular cerebral isquêmico (AVCI) é consenso na literatura mundial [1][2][3][4] . O controle de hipertensão arterial em pacientes na fase aguda do AVCI com indicação de trombólise sistêmica e intra-arterial tem sido recomendado1.…”

“…O controle de hipertensão arterial em pacientes na fase aguda do AVCI com indicação de trombólise sistêmica e intra-arterial tem sido recomendado1. O manejo intensivo da PA de 15 em 15 minutos nas primeiras 2 horas, de 30 em 30 minutos nas primeiras 6 horas e de 60 em 60 minutos nas primeiras 24 horas é recomendação para boa prática médica e melhor evolução do paciente 2 .…”