Stroke precipitated dy moderate blood pressure reduction

Rapid lowering of blood pressure can precipitate or worsen ischemic strokes . This usually has been observed in the setting of profoundly lowered press ure and hypotension. We report on six patients in whom ischemic neurologic injury ensued or worsened after moderate reduction of blood pressure by pha rmacological treatment, The 6 patients suffered new or worsened ischemic ne urologic deficits after receiving oral or intravenous antihypertensive medi cations, mostly after relatively small doses. Mean arterial blood pressure in these patients was decreased by 25 +/- 7.7%, or 37 +/- 16 mm Hg (mean +/ - SD) without resultant hypotension. These cases emphasize the potential ha zards of moderate blood pressure reduction by antihypertensive medications in the setting of an acute ischemic stroke or transient ischemic attack (TI A), as well as rapidly treated hypertension even in those who have not yet manifested ischemir symptoms. (C) 2000 Elsevier Science Inc.