How is hypertension treated in basilar artery thrombosis?

Updated: Jan 11, 2019
  • Author: Salvador Cruz-Flores, MD, MPH, FAHA, FCCM, FAAN, FACP, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

If the patient has a fluctuating neurologic condition and his or her blood pressure requires close monitoring, an arterial catheter should be placed.

No evidence from randomized trials indicates that treating hypertension is better than not treating it. However, currently available guidelines for the management of acute stroke recommend the use of antihypertensives to lower blood pressure to a systolic value of less than 185 mm Hg or a diastolic value of less than 110 mm Hg if thrombolysis is being considered. (Some evidence, however, suggests that in selected cases, induced hypertension may be beneficial for limiting ischemic injury.)

Hypertension should also be treated if the patient has evidence of acute end organ damage, such as hypertensive encephalopathy, unstable angina or acute myocardial infarction, heart failure, or acute renal failure. Otherwise, treatment is indicated only when the diastolic blood pressure is greater than 120 mm Hg or the systolic blood pressure is greater than 220 mm Hg.

The preferred antihypertensive agents are nicardipine and labetalol. When diastolic blood pressure is greater than 140 mm Hg and not responsive to nicardipine and labetalol, then nitroprusside should be used.

Overzealous treatment of hypertension should be avoided because it can exacerbate the ongoing ischemia.


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