Pathophysiology and management of hypertension in acute ischemic stroke.

Hypertension, defined in different ways by various investigators over a period of many years, has been shown to be a major risk factor for stroke. 1 - 2 In fact, the strength of the evidence suggests that hypertension causes stroke. But by what mechanisms? The value of treating chronic hypertension to prevent stroke is well established, but what should be done about blood pressure elevations in the setting of acute stroke? Stroke is a generic term for a clinical syndrome that includes focal cerebral infarction (ischemic stroke), focal hemorrhage in the brain, and subarachnoid hemorrhage. 3 Hypertension is an important precursor of cerebral infarction and intracerebral hemorrhage. Whether hypertension predisposes to subarachnoid hemorrhage is less certain because of conflicting evidence from epidemiologic, clinical, and laboratory investigations. 47 This article will focus on the pathophysiology and management of elevated blood pressure in the setting of acute ischemic stroke. A review of the subject seems timely given the frequency of the problem, the paucity of clinically relevant scientific data, 8 and contemporary interest in salvaging ischemic brain before infarction occurs. 9 - 10