Blood Pressure Lowering After Stroke
When, How much & with What?
Nguyễn Huy Thắng
Cerebrovascular Disease Department
People ‘s 115 Hospital


Stroke
4635 pts
Ischaemic
3620 pts (78.1%)

Haemorrhagic
1015 pts (21.9%)

• Male: 51%

• Male: 64%

• Hypetension: 84.8%

• Hypetension: 94%

• Hyperlipidaemia: 79.7%

• Hyperlipidaemia : 53.1%

• History of stroke: 22.3%

• History of stroke: 13.8%


• Các trường hợp cần lưu ý


Penumbra Concept


• CBF

=

CPP

/

CVR

(Cerebral Blood Flow) (Cerebral Perfusion Pressure) / (CerebroVascular Resistance)

• CPP

=

MAP – Venous Back Pressure

• CPP

#

MAP (Mean Arterial Pressure)



Class I, Level of Evidence C
Stroke. 2007;38:1655-1711


Kiểm Soát Huyết Áp Sau Đột Qụy
• Có nên giảm huyết áp trong đột quỵ?

• Khi nào bắt đầu?
• Giảm bao nhiêu?

• Lựa chọn thuốc?
• Các trường hợp cần lưu ý


2.6
2.97
4.36



• Blood pressure reduction is recommended in
persons who have had an ischemic stroke or

TIA are beyond the first 24 hours with
neurological symptoms stable.
(Class I; Level of Evidence A)
Stroke. 2011;42:227-276.




after onset of stroke…”

Stroke 2007; 38: 1655


• A target systolic blood pressure of 180 mmHg and
diastolic blood pressure of 100-105 mmHg is
recommended in patients with prior hypertension

• Patients without prior hypertension: 160-180/ 90100 mmHg
Cerebrovasc.Dis 2003; 16: 331


Kiểm Soát Huyết Áp Sau Giai Đoạn Cấp


AHA/ASA Guidelines for Stroke 2014
• Initiation of BP therapy is indicated for previously
untreated patients with ischemic stroke or TIA have
an established BP ≥140 mm Hg systolic or ≥90 mm
Hg diastolic
(Class I; Level of Evidence B).

• Resumption of BP therapy is indicated for
previously treated patients with known
hypertension for both prevention of recurrent
stroke and prevention of other vascular events in
those who have had an ischemic stroke or TIA
(Class I; Level of Evidence A)