To the Editor.
—Dr Lavin states: "Certainly, if the blood pressure is to be reduced in patients with cerebral hemorrhage, it should be done cautiously, not aggressively with a short-acting hypotensive agent such as sodium nitroprusside...."1Many would argue that sodium nitroprusside is not the agent of choice since intracranial pressure has been observed to increase dramatically in some cases with a decrease in cerebral perfusion pressure.2 In fact, in the first case report Dr Lavin presented, hydralazine's effect could have been mediated through a rise in intracranial pressure rather than a decrease in systemic arterial pressure. Only by simultaneously measuring intracranial and systemic arterial pressures can we accurately know cerebral perfusion pressure, and only then can we "guess" at regional blood flow. For it is regional blood flow that is really our concern when speaking of ischemic nervous tissue.Many intensivists prefer trimethaphan camsylate for its minimal
Garner L. Sodium Nitroprusside Treatment in Patients With Acute Strokes. Arch Intern Med. 1986;146(7):1454. doi:10.1001/archinte.1986.00360190246045