ISC gives 4 recommendations for blood pressure management in acute ischemic stroke!

*Only for medical professionals to read for reference, covering the whole process of early stroke, thrombolysis, thrombectomy and stable phase! The blood pressure management of acute ischemic stroke is a problem that clinicians must face, but when to start blood pressure reduction, what is the target value for blood pressure reduction, and when to resume blood pressure medication after stroke, these are often encountered by clinicians Confusion.

On the morning of March 17, US Eastern Time, the 2021 American Stroke Association (ASA) Scientific Annual Meeting was held as scheduled.
Professor Skye Coote from the Royal Melbourne Hospital explained to us "Blood Pressure Management in Acute Ischemic Stroke".
Suggestions are given in 4 aspects after thrombolysis, thrombectomy and stable period.
The content is wonderful, let us have a quick look! 01 Blood pressure management in the early stage of stroke Figure 1: Courseware from the lecturer Based on the understanding of the guidelines, all patients with acute ischemic stroke should closely monitor their blood pressure within 48 hours after the onset of stroke.

Some observational studies have shown that there is an association between a poorer prognosis of acute ischemic stroke and lower blood pressure.

Therefore, correcting hypotension and hypovolemia and maintaining the systemic perfusion level required for organ function is the key to blood pressure management after stroke.

For patients with severe comorbidities with systolic blood pressure> 200 mmHg or diastolic blood pressure> 110 mmHg, without intravenous thrombolysis and intravascular treatment, and no emergency blood pressure reduction treatment, blood pressure can be reduced by 15% within 24 hours after the onset.

For patients with ischemic stroke who are already taking antihypertensive drugs, the treatment of hypertension drugs can be stopped under safe conditions, and blood pressure levels should be closely monitored during the process.

02 Blood pressure management after stroke thrombolysis Figure 2: From the lecturer's courseware For acute ischemic stroke patients who are suitable for intravenous thrombolysis, their blood pressure should be reduced to below 185/110mmHg before and within 24 hours after treatment.

For patients with elevated blood pressure and eligible for alteplase treatment, blood pressure should be lowered carefully before thrombolytic therapy.
The blood pressure should be maintained below 185/110mmHg before alteplase treatment.
The blood pressure should be maintained 24 hours after alteplase treatment.
Maintain below 180/105 mmHg.

03 Blood pressure management after stroke thrombectomy Figure 3: From the lecturer's courseware For patients who are preparing for mechanical thrombectomy and not receiving intravenous thrombolysis, their blood pressure should be controlled at systolic blood pressure <180 mmHg and diastolic blood pressure <100 mmHg.

The blood pressure management of patients who plan to undergo intra-arterial treatment can refer to this standard, and control the postoperative blood pressure level according to the vascular opening to avoid overperfusion or hypoperfusion.

In 5 randomized controlled trials (REVASCAT, SWIFT PRIME, EXTEND-IA, THRACE, and MR CLEAN), each independent trial demonstrated the clinical benefits of mechanical thrombectomy within 6 hours after the onset of ischemic stroke.
The trial has very strict blood pressure management.
The preoperative blood pressure of most patients is lower than 180/100 mmHg.

04 Blood pressure management guidelines for stable stroke recommends that patients with acute ischemic stroke with blood pressure> 220/120mmHg should carefully lower their blood pressure (not more than 20%) in the first 24 hours.

After the stroke, the condition is stable.
If the blood pressure continues to be ≥140/90 mmHg, if there is no contraindication, the antihypertensive treatment can be started, and the antihypertensive drugs before the onset are generally used.

Summary At present, research on whether blood pressure should be lowered immediately in the early stage after acute ischemic stroke, the target value of blood pressure, when to resume the use of antihypertensive drugs after stroke, and the choice of antihypertensive drugs are gradually increasing, but they lack sufficient and uniformity Research evidence.

Future direction: Conduct targeted clinical trials of acute ischemic stroke, and conduct subgroup analysis, including comparison of ischemic and hemorrhagic stroke, comparison of reperfusion therapy and non-reperfusion therapy, and large vessel disease and small vessel disease Contrast, etc.
, to obtain more sufficient and reliable evidence-based medical evidence for blood pressure management in ischemic stroke.Reference materials: [1]Powers WJ, et a1.
Guidelines for the Early Management of Patients With Acute Ischemic Stroke.
A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.
Stroke.
2018, 49(3):e46- 110.
[2]Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2018.
[J]Chinese Journal of Neurology, 2018,51(9):666-682[3]Chinese Guidelines for the Diagnosis and Treatment of Early Endovascular Intervention in Acute Ischemic Stroke 2018.
[J] Journal of Neurology, 2018,51 (9): 683-691 This article source: Neurology medical profession channel author: ISC group reported --Liny review article: Li Tu Ming, deputy director of physicians editor: Mr.
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