This is a non-TPA article regarding the medical management of hypertension in acute ischemic stroke in the Emergency Department.
The authors remind us that for every 10 mmHg drop in SBP <150 mmHg, there is a 17.9% increase in risk for death at 14 days. They additionally remind us that antihypertensive therapy is only recommended for BP >220/120 mmHg, with a 15-25% goal decrease in the first 24 hours.
This is a retrospective review of cases from 16 Cincinnati region hospitals looking at the blood pressure observed in the ED along with any treatment. They found 1739 cases, 1520 of whom did not receive treatment and 219 who did. It turned out that 2.6% of the non-treated patients should have had some blood pressure lowering – oops. But, amazingly even worse, only 31.5% of patients who did receive treatment actually required lowering.
Of the 217 patients that were treated, 52 of them had greater than a 20% drop in blood pressure in the Emergency Department. So, we treat a lot of blood pressure that shouldn’t be treated – and when we treat it, it is not uncommon to treat it too aggressively.
Stop it!
“Emergency Department Adherence to American Heart Association Guidelines for Blood Pressure Management in Acute Ischemic Stroke”
http://www.ncbi.nlm.nih.gov/pubmed/22033993