Τίτλος:
European Stroke Organisation (ESO) guidelines on blood pressure
management in acute ischaemic stroke and intracerebral haemorrhage
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
The optimal blood pressure (BP) management in acute ischaemic stroke
(AIS) and acute intracerebral haemorrhage (ICH) remains controversial.
These European Stroke Organisation (ESO) guidelines provide
evidence-based recommendations to assist physicians in their clinical
decisions regarding BP management in acute stroke. The guidelines were
developed according to the ESO standard operating procedure and Grading
of Recommendations, Assessment, Development, and Evaluation (GRADE)
methodology. The working group identified relevant clinical questions,
performed systematic reviews and meta-analyses of the literature,
assessed the quality of the available evidence, and made specific
recommendations. Expert consensus statements were provided where
insufficient evidence was available to provide recommendations based on
the GRADE approach. Despite several large randomised-controlled clinical
trials, quality of evidence is generally low due to inconsistent results
of the effect of blood pressure lowering in AIS. We recommend early and
modest blood pressure control (avoiding blood pressure levels >180/105
mm Hg) in AIS patients undergoing reperfusion therapies. There is more
high-quality randomised evidence for BP lowering in acute ICH, where
intensive blood pressure lowering is recommended rapidly after hospital
presentation with the intent to improve recovery by reducing haematoma
expansion. These guidelines provide further recommendations on blood
pressure thresholds and for specific patient subgroups. There is ongoing
uncertainty regarding the most appropriate blood pressure management in
AIS and ICH. Future randomised-controlled clinical trials are needed to
inform decision making on thresholds, timing and strategy of blood
pressure lowering in different acute stroke patient subgroups.
Συγγραφείς:
Sandset, Else Charlotte
Anderson, Craig S.
Bath, Philip M. and
Christensen, Hanne
Fischer, Urs
Gasecki, Dariusz
Lal, Avtar
and Manning, Lisa S.
Sacco, Simona
Steiner, Thorsten and
Tsivgoulis, Georgios
Περιοδικό:
European Stroke Journal
Εκδότης:
SAGE Publications Ltd
Λέξεις-κλειδιά:
ischaemic stroke; intracerebral haemorrhage; blood pressure;
hypertension; guidelines; recommendations; antihypertensive; blood
pressure lowering
DOI:
10.1177/23969873211026998
