How is hypertension managed following middle cerebral artery (MCA) stroke?

Updated: Feb 20, 2018
  • Author: Daniel I Slater, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Answer

More passive blood pressure management is pursued in acute care for ischemic stroke owing to concern for endangering the penumbra or area immediately adjacent to infarcted brain tissue. The target blood pressure for acute ischemic stroke within the first 24-72 hours is below 220/120 mm Hg. In the case of hemorrhagic stroke, pressure management is much more critical and remains important long term. Generally, the target is below 160/90 mm Hg, although new research shows benefit of lowering blood pressure even more aggressively. [14]

Again, the focus of this article is postacute stroke treatments. After 72 hours, it is prudent and safe to begin normalizing blood pressure, except in the rare case that the stroke is thought to have been caused by hemodynamic instability. Target blood pressures are below 140/90 mm Hg, except in patients with nephropathy or diabetes, for which the target is below 130/80 mm Hg. [15]


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