Hypertension Treatment in stroke

2004/8/27

A.   Ischemic stroke

1.      DBP > 140 mmHg, nitroprusside infusion (0.5mg/kg/min) then titrate

2.      SBP > 220 mmHg, or DBP:120~140 mmHg, MBP>130 mmHg, labetalol IV 10mg/q10~20 min (max:300mg), avoided in asthma, congestive heart failure, severe cardiac conduction abnormality,

Enalapril PO, for maintenance particularly in congestive heart failure

3.      SBP:185~220 mmHg, DBP:105~120 mmHg, no hypertensive treatment except in left ventricular failure, aortic dissection, acute myocardial ischemia, t-PA therapy

4.      SBP , 185 mmHg, DBP < 105 mmHg, no hypertensive treatment

B.    Hemorrhagic stroke

1.      SBP > 230 mmHg, DBP > 140 mmHg, nitroprusside infusion

2.      SBP:180~230 mmHg, DBP: 105~140 mmHg, MBP > 130 mmHg, labetalol IV or enalapril, verapamil, diltiazem

3.      SBP < 180 mmHg, DBP < 105 mmHg, no hypertensive treatment

4.      keep cerebral perfusion pressure (CPP) > 70 mmHg, if necessary volume replacement then dopamine, norepinephrine infusion