TREATMENT OF POST STROKE HYPERTENSION - A PRACTICAL GUIDE

Cerebrovascular disease is a common cause of morbidity and mortality, especially in the elderly. Treatment of hypertension is effective in t he primary prevention of stroke. Hypertension is seen in 80% of acute stroke patients but, by the tenth day after admission to hospital, onl y one-third are still hypertensive. The clinical significance of post- stroke hypertension is uncertain and its management is a contentious i ssue. In this article we review current evidence regarding the risks a nd benefits of the treatment of post-stroke hypertension. The pathophy siology of post-stroke hypertension is described in relation to autore gulation of cerebral blood flow after cerebral infarction or haemorrha ge. In the absence of clinical trial data, recommendations for early t reatment of post-stroke hypertension are based on a review of expert o pinion that immediate, controlled lowering of blood pressure after acu te stroke is required only in defined situations such as hypertensive encephalopathy or aortic dissection. There are no reliable data regard ing the comparative effects of different hypotensive agents after acut e stroke; short-acting vasodilator drugs are recommended if treatment is essential. The benefits of hypotensive therapy is secondary prevent ion of recurrent stroke are uncertain but the results of large clinica l trials in progress should provide helpful guidelines for clinical pr actice.