A 68-year-old man with a history of hypertension and coronary artery disease presents with right sided weakness, sensory loss, and an expressive aphasia. Neuroimaging studies are shown.
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In the emergency department the patient’s blood pressure is persistently 160/95.
Which of the following is the best next step in management of this patient’s blood pressure?
a. Administer IV nitroprusside.
b. Administer oral clonidine 0.1 mg po until the blood pressure drops below 140/90.
c. Observe the blood pressure.
d. Administer IV mannitol.
e. Administer IV labetolol.
Answer And Discussion:
The answer is c. (Observe the blood pressure.)
Although hypertension is an important cause of stroke, it should not be aggressively treated in the setting of acute cerebral ischemia. Since cerebral autoregulation is disrupted in acute stroke, a drop in blood pressure can decrease perfusion and worsen the so-called ischemic penumbra. Generally, blood pressure elevation up to 185/110 is not treated.
Some stroke specialists recommend more aggressive blood pressure control in acute intracranial hemorrhage, but this patient has an ischemic (not hemorrhagic) stroke.
Mannitol is of minimal benefit in cerebral edema associated with acute stroke.
In the emergency department the patient’s blood pressure is persistently 160/95.
Which of the following is the best next step in management of this patient’s blood pressure?
a. Administer IV nitroprusside.
b. Administer oral clonidine 0.1 mg po until the blood pressure drops below 140/90.
c. Observe the blood pressure.
d. Administer IV mannitol.
e. Administer IV labetolol.
Answer And Discussion:
The answer is c. (Observe the blood pressure.)
Although hypertension is an important cause of stroke, it should not be aggressively treated in the setting of acute cerebral ischemia. Since cerebral autoregulation is disrupted in acute stroke, a drop in blood pressure can decrease perfusion and worsen the so-called ischemic penumbra. Generally, blood pressure elevation up to 185/110 is not treated.
Some stroke specialists recommend more aggressive blood pressure control in acute intracranial hemorrhage, but this patient has an ischemic (not hemorrhagic) stroke.
Mannitol is of minimal benefit in cerebral edema associated with acute stroke.