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KMID : 1201420110040000006
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Journal of Neurocritical Care
2011 Volume.4 No. 0 p.6 ~ p.12
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Blood Pressure Control in Neurocritical Patients: Focusing on the Blood Pressure Control during Acute Phase of Stroke
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Oh Seung-Hun
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Abstract
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Stroke is one of the most commonly encountered diseases in neurocritical care. Reducing blood pressure is well-established key element for primary or secondary prevention for stroke. However, whether lowering BP is protective or harmful during acute phase of stroke is still inconclusive. Acute hypertensive response occurs in 50-80% of patients in the acute phase of stroke, and is associated with poor outcome. Emerging evidence suggests that the relationship between the clinical outcome and BP is U-shaped pattern, and both extremely high and low BP show detrimental effect on clinical outcome. The effect of induced hypertensive therapy in acute ischemic stroke remains uncertain. Lowering BP is associated with favorable outcome in intracerebral hemorrhage and subarachnoid hemorrhage although further clinical trials are required for confirmation. Vasoactive agent including oral nimodipine protects vasospasm and secondary ischemia in subarachnoid hemorrhage, and improves clinical outcome. Current guideline for the management of blood pressure in patients with acute stroke are not evidence-based, but results from ongoing trials might provide more valuable information on the safety and efficacy of BP control in acute stroke.
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KEYWORD
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Stroke, Blood pressure, Management, Guideline
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