Most patients with acute ischemic strokes are hypertensive1 and pose an almost daily dilemma of whether to treat their blood pressure on admission or not. Yatsu and Zivin emphasize the dangers of decreasing brain perfusion further, producing watershed infarction and facilitating thrombus formation by treating hypertension acutely. Spence and Del Maestro agree, but they argue that these risks are outweighed by the hazards of not treating hypertension. In acute ischemic stroke the brain commonly loses the ability to regulate its own blood supply, cerebral perfusion varying with the systemic blood pressure. A high perfusion pressure promotes edema formation, increasing intracranial pressure and ischemia.
Wallace and Levy2 studied 334 patients with acute stroke, half of whom had a history of hypertension. During the first 24 hours after admission, 84% of the patients showed hypertension (supine blood pressure >150/90 mm Hg), whereas only one third of the patients remained hypertensive
Hachinski V. Hypertension in Acute Ischemic Strokes. Arch Neurol. 1985;42(10):1002. doi:10.1001/archneur.1985.04060090084020
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