Previous studies have shown that hypertension is a significant and independent risk factor for ICH and SAH. 4,5 Treatment of hypertension has been demonstrated to be the most important factor in reducing the incidence of stroke 6 as well as decreasing the risk of cardiovascular disease. 7 We examined the hypothesis that untreated hypertension was a significant risk factor for hemorrhagic stroke.
Full Answer
Should all hypertensive patients with hypertension be treated for hemorrhagic stroke?
Hypertension, even if treated, was still a significant risk factor for hemorrhagic stroke. Thus, even if all hypertensive patients received treatment, there would likely still be an increased risk of stroke.
Is there a relationship between hypertension and stroke?
We highlight the details of elevated blood pressure management in the hyperacute/acute, subacute, and chronic stages of ischemic stroke and intracerebral hemorrhage. The relationship between hypertension and stroke is dynamic and multifaceted.
What is the frequency of hypertension after a stroke?
Its frequency varies across studies due to variability in patient characteristics, settings and criteria used to define hypertension, but a systematic review of 18 observational studies reported a 53% frequency of hypertension (systolic BP, 150–200 mmHg) in the setting of acute stroke [Willmot et al. 2004].
Can tighter blood pressure control help stroke patients?
In CATIS, patients with small “lacunar” strokes seemed to benefit somewhat from tighter blood pressure control. These small strokes, which often occur deep in the brain where they can do a disproportionately large amount of damage, are especially associated with hypertension.
Why is hypertension in particular associated with hemorrhagic stroke?
High blood pressure causes damage to the inner lining of the blood vessels. This will narrow an artery. About 13% of strokes occur when a blood vessel ruptures in or near the brain. This is a hemorrhagic stroke.
How does hypertension affect hemorrhagic stroke?
The extra strain that high blood pressure puts on your blood vessels may cause a weakened blood vessel to burst inside the brain, causing bleeding on and into surrounding tissues. This is called a haemorrhagic stroke.
Why is it important to keep a patient's blood pressure elevated after a stroke?
If you have a stroke and survive the first month, your likelihood of dying in the first year after the stroke is about 10%,1 and your risk of having a second stroke in the next 10 years is 43%. Treatment of elevated blood pressure reduces the risk of recurrent stroke by 30%.
How do hemorrhagic strokes manage blood pressure?
Blood Pressure Control Suggested agents for use in the acute setting are beta blockers (eg, labetalol) and angiotensin-converting enzyme inhibitors (ACEIs) (eg, enalapril). For more refractory hypertension, agents such as nicardipine and hydralazine are used.
Why do stroke patients have hypertension?
Hypertension is one of the most common and important risk factors for the development of ischemic stroke. When stroke occurs, the blood pressure (BP) often rises because of various factors, such as psychological stress, pain, elevated intracranial pressure, urinary retention, and hypoxemia.
When is antihypertensive used in hemorrhagic stroke?
The EUSI in 2006 [6] recommended that antihypertensive treatment should be initiated in patients with ICH and chronic hypertension if SBP is ≥180 mm Hg. The Writing Group of the AHA Stroke Council [3] in 1999 recommended starting antihypertensive treatment if SBP is ≥180 mm Hg or DBP is ≥105 mm Hg.
When is hypertension treated for stroke?
Should Blood Pressure Be Lowered in Patients With Elevated BP After an Ischemic Stroke? Answer: As per the AHA/ASA guidelines, it is recommended that before intravenous thrombolytic treatment, BP should be lowered if >185 mm Hg systolic or >110 mm Hg diastolic.
How does hypertension cause blood clots?
High blood pressure damages the walls of your arteries. This makes them more likely to develop deposits of plaque that harden, narrow or block your arteries. These deposits also can lead to blood clots.
When do you start antihypertensive after a stroke?
In patients who were not receiving antihypertensive treatment before the ischemic stroke and who have a baseline systolic pressure of 180–220 mm Hg and a diastolic pressure below 120 mm Hg, antihypertensive therapy should be deferred for the first 48 hours after the stroke, unless thrombolytic therapy is indicated.
Why is it important not to lower blood pressure too much in a patient with a suspected stroke?
More than 60% of patients with acute ischemic stroke (AIS) present with elevated BP within 1 hour of symptom onset. Elevated BP can affect thrombolytic eligibility and has been associated with delay in administration of IV tissue plasminogen activator (IV tPA).
How does hemorrhage affect blood pressure?
The reduction in blood volume during acute blood loss causes a fall in central venous pressure and cardiac filling. This leads to reduced cardiac output and arterial pressure.
Why is thrombolytic therapy contraindicated in hypertension?
Background. Intravenous thrombolysis (IVT) with (recombinant) tissue plasminogen activator is an effective treatment in acute ischemic stroke. However, IVT is contraindicated when blood pressure is above 185/110 mmHg, because of an increased risk on symptomatic intracranial hemorrhage.
Methods
All patients in the greater Cincinnati/northern Kentucky region who have a potential ICH or SAH are identified by surveillance of all 16 adult hospital emergency and radiology departments and through hospital discharge diagnoses (International Classification of Diseases 9: 430 to 438.9).
Results
Between May 1997 and December 2002, 3413 potential cases of hemorrhagic stroke were reviewed, but 1388 had at least 1 exclusion criterion: trauma (627); no hemorrhage (226); hemorrhagic conversion of ischemic stroke (188); hemorrhage into tumor (145); resident outside 50-mile radius (188); hemorrhage occurring outside of the study time period (11); and <18 years of age at time of stroke (3).
Discussion
We report that untreated hypertension is an important risk factor for both ICH and SAH. Because of the importance of hypertension to both ICH and SAH, we examined its importance to the overall category of hemorrhagic stroke as well as the major subtypes.
Footnotes
Correspondence to Dr Daniel Woo, Assistant Professor of Neurology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0525, Cincinnati, OH 45267-0525. E-mail [email protected]
How long does it take for blood pressure to go up after stroke?
The strategy of "permissive hypertension" involves stopping blood pressure medications for a set period of time after a stroke—usually no more than 24 to 48 hours —in order to widen blood vessels and improve blood flow in the brain. During this time, the systolic blood pressure may rise as high as 220 mmHg ...
What is considered a risk factor for stroke?
Permissive Hypertension. High blood pressure , also called hypertension, is a widely recognized risk factor for stroke. So it may surprise some people to see that, after someone has had a stroke, doctors may stop blood pressure medications and allow the pressure to seemingly soar. Why is that?
Can blood flow through a blocked vessel?
This can be achieved in a few ways. In some cases, blood may be able to flow through an alternative blood vessel to reach the brain. In other cases, a blocked vessel may reopen partially, allowing some blood to flow through.
Is there a blood pressure reading for ischemic stroke?
Guidelines jointly published by the American Heart Association and American Stroke Association on the early treatment of ischemic stroke note that there is no one ideal blood pressure reading for patients experiencing ischemic stroke.
Abstract
Hypertension is a well-established and modifiable risk factor for stroke and other cardiovascular diseases. Notably, stroke is the second leading cause of death worldwide and the second most common cause of disability-adjusted life-years.
Footnotes
The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.
What is the most common risk factor for stroke?
Hypertension is the most prevalent risk factor for stroke. Stroke causes and haemodynamic consequences are heterogeneous which makes the management of blood pressure in stroke patients comple …. Stroke is the second most common cause of mortality worldwide and the third most common cause of disability. Hypertension is the most prevalent risk factor ...
Is stroke a cause of disability?
Stroke is the second most common cause of mortality worldwide and the third most common cause of disability. Hypertension is the most prevalent risk factor for stroke. Stroke causes and haemodynamic consequences are heterogeneous which makes the management of blood pressure in stroke patients complex requiring an accurate diagnosis ...
Abstract
Elevated blood pressure (BP) is the leading modifiable risk factor for stroke and the benefit of BP lowering therapy on the stroke risk reduction is well established.
Introduction
Worldwide, more than one billion people have elevated blood pressure (BP) [ 1 ], and elevated BP is the leading modifiable risk factor for stroke [ 2 ].
BP Control for Primary Stroke Prevention
Multiple epidemiological studies showed that high BP was associated with an increased risk of stroke mortality.
BP Control for Secondary Stroke Prevention
About 70% of stroke patients have hypertension [ 25 - 28 ]. In contrast to primary stroke prevention, there is no large epidemiological study that evaluates whether high BP is associated with an increased risk of recurrent stroke.
Intensive vs. Less Intensive BP Lowering for Stroke Prevention
As previously described, large meta-analyses of epidemiological studies showed that the association of BP and the stroke incidence as well as stroke mortality is continuous down to 115/75 mm Hg, suggesting “the lower, the better.” The expected benefit was consistent across a wide range of subgroups [ 3 - 5 ].
BP Management in Acute Stroke
In a representative large data set in the US involving 563,704 patients with stroke admitted to ER, initial SBP was 140–184 mm Hg in 56%, and ≥185 mm Hg in 13% [ 62 ]. In the majority of patients, BP spontaneously falls over the first 7 days after stroke onset.
Summary
RCTs confirmed the epidemiologically expected benefits of BP lowering for the prevention of stroke and major cardiovascular events. Among several antihypertensive classes, which one is better for stroke prevention is still less clear, and adequate BP lowering is of great importance.