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Management of Hypertension in Acute Stroke
Stroke Care
Stroke – Post Thrombolysis
Stroke Thrombolysis
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Management of Hypertension in Acute Stroke
Last updated 13th March 2024
Acute Ischaemic Stroke
- The only thing we’re sure about for BP lowering after acute ischaemic stroke is the BP target for thrombolysis.
- The many RCTs are inconclusive about stopping/ continuing antihypertensive drugs, or specific BP targets in almost all other settings.
Acute Haemorrhagic Stroke
- Consider for urgent treatment within 6 hours of symptom onset using IV labetolol or IV nitrate, aiming to achieve SBP 130-139mmHg within 1 hour and sustained for at least 7 days unless:
- GCS ≤5
- Haematoma is very large and death expected
- a macrovascular or structural cause for the haematoma is identifed
- immediate surgery to evacuate the haematoma is planned in which case discuss with Neurosurgical Team
- Move patient to critical care for IV anti-hypertensive therapy
- Monitor for conscious level and refer immediately for repeat brain imaging if deteriorates
Content by Chris Isles