Stroke precipitated by moderate blood pressure reduction.
ABSTRACT Rapid lowering of blood pressure can precipitate or worsen ischemic strokes. This usually has been observed in the setting of profoundly lowered pressure and hypotension. We report on six patients in whom ischemic neurologic injury ensued or worsened after moderate reduction of blood pressure by pharmacological treatment. The 6 patients suffered new or worsened ischemic neurologic deficits after receiving oral or intravenous antihypertensive medications, mostly after relatively small doses. Mean arterial blood pressure in these patients was decreased by 25 +/- 7.7%, or 37 +/- 16 mm Hg (mean +/- SD) without resultant hypotension. These cases emphasize the potential hazards of moderate blood pressure reduction by antihypertensive medications in the setting of an acute ischemic stroke or transient ischemic attack (TIA), as well as rapidly treated hypertension even in those who have not yet manifested ischemic symptoms.
Article: Hypertensive emergency and severe hypertension: what to treat, who to treat, and how to treat.[show abstract] [hide abstract]
ABSTRACT: Remember to treat patients, not numbers. Use fast acting shortterm medicines only when convincing evidence of rapidly evolving end-organ damage is present. For all patients, emergent or asymptomatic, the treatment goal is long-term control of hypertension. Potent IV agents for the im-mediate control of elevated blood pressure need to be used cautiously,bearing in mind both the side effects and the hazards of overly rapid control of hypertension. Conventional oral medication regimens demonstrated to modify the risks of chronic hypertension should be used whenever possible and as early as is practical to promote gradual control of hypertension. Whenever a patient presents for the evaluation of severe hypertension in an emergent setting, take the opportunity to encourage appropriate ongoing follow-up; after all, hypertension is not a single episode, it is an ongoing threat to good health.Medical Clinics of North America 06/2006; 90(3):439-51. · 2.47 Impact Factor