Early treatment of hypertension in acute

ischemic and intracerebral hemorrhagic

stroke: Progress achieved, challenges, and
perspectives
Carlos A. Feldstein, MD
Hospital de Clnicas Jos de San Martn, Hypertension Program, Av. Crdoba 2351, 7th floor,
Ciudad Autnoma de Buenos Aires 1120, Argentina
DOI: http://dx.doi.org/10.1016/j.jash.2013.09.004
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Publication History
Published Online: November 11, 2013Accepted: September 27, 2013Received: August 5,
2013
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Abstract
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Abstract
Hypertension is the leading risk factor for ischemic and intracerebral hemorrhagic subtypes of
stroke. Additionally, high blood pressure (BP) in the acute cerebrovascular event is associated
with poor outcome, and a high percentage of stroke survivors have inadequate control of
hypertension. The present is a systematic review of prospective, randomized, and controlled
trials carried out on safety and efficacy of antihypertensive treatment of both subtypes of
acute stroke. Six trials involving 7512 patients were included, which revealed controversies
on the speed and the goals of treatment. These controversies could be due at least in part, from
the fact that some studies analyzed the results of antihypertensive treatment in ischemic and
intracerebral hemorrhagic subtypes of acute stroke together, and from a different prevalence
of past-stroke in the randomized groups. Further research is necessary to establish whether
standard antihypertensive treatment provides greater benefit than simple observation in
patients with ischemic acute stroke and Stage 2 hypertension of JNC 7, albeit they were not
candidates for acute reperfusion. In that case, the target reduction in BP could be 10% to 15%
within 24 hours. The recently published INTERACT 2 has provided evidence that patients
with hemorrhagic stroke may receive intensive antihypertensive treatment safely with the goal
of reducing systolic BP to levels no lower than 130 mm Hg. It is important to take into
account that marked BP lowering in acute stroke increases the risk of poor outcome by
worsening cerebral ischemia from deterioration of cerebral blood flow autoregulation.
Keywords:

Acute stroke, blood pressure elevation

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Conflict of interest: none.
2014 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.
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