This month in Journal Club, we continued our theme of prognostication papers as Corey reviewed two recent ones from Latha G. Stead’s group at Mayo. One paper ran last year and is called “Initial Emergency Department Blood Pressure as Predictor of Survival After Acute Ischemic Stroke” (Neurology 2005, 65:1179:1183). The second paper is called “Impact of Acute Blood Pressure Variability on Ischemic Stroke Outcome” (Neurology 2006:66:1878-1881).

This is something I frankly hadn’t spent much time thinking about — all the emphasis in stroke guidelines and tPA admin has been about getting BP down into a safe range, not worrying about whose BP is too low. But the big result from the first paper was that a diastolic of 120 mm Hg or unless the systolic blood pressure is >220 mm Hg (level V).

When treatment is indicated, lowering the blood pressure should be done cautiously. Parenteral agents such as labetalol that are easily titrated and that have minimal vasodilatory effects on cerebral blood vessels are preferred. In some cases, an intravenous infusion of sodium nitroprusside may be necessary for adequate blood pressure control…. Thrombolytic therapy is not given to patients who have a systolic blood pressure >185 mm Hg or a diastolic blood pressure >110 mm Hg at the time of treatment.

More useful, practical tips on BP control in acute stroke (and its subsequent effects on your decision to thrombolyze) can be found on emcrit.org. As usual, more thoughts on these papers or the topics they raise is welcome in the comments section below.

Source: http://journal.sinaiem.org/