HYPERTENSION MANAGEMENT IN - EMCREG-International
HYPERTENSION MANAGEMENT IN - EMCREG-International
HYPERTENSION MANAGEMENT IN - EMCREG-International
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
<strong>HYPERTENSION</strong> <strong>MANAGEMENT</strong> <strong>IN</strong>ACUTE NEUROVASCULAR EMERGENCIESmyocardial infarction, aortic dissection, hypertensiveencephalopathy, acute renal failure, acute pulmonaryedema, etc.), or patients with extremes of blood pressure(systolic above 220 or diastolic above 120). 5The clearest indication for blood pressure lowering inthe setting of acute ischemic stroke is in patients whoare candidates for fibrinolytic therapy. In this population,elevated blood pressure significantly increases the risk ofintracerebral hemorrhage. Fibrinolytic therapy should notbe given to patients who have a systolic blood pressure>185 mm Hg or a diastolic blood pressure >110 mm Hg atthe time of treatment. 5,7 Often stroke patients arrive withvery elevated blood pressure, but it may fall within theseparameters after a few minutes without specific therapy. Ifnot, guidelines for fibrinolytic therapy allow for treatmentof the blood pressure with relatively modest measures,including intravenous labetalol boluses, enalaprilatand some centers are now using nicardipine infusion.However, very aggressive interventions to lower bloodpressure should not be used, so if the above measuresare not effective in achieving the blood pressure targets,then fibrinolytic therapy is contraindicated. If the patientis treated with a fibrinolytic, the blood pressure must bemaintained