Management of Arterial Hypertension in Patients With Acute Ischemic Stroke(Special Issue in Hornor of the Retirement of Professor Makoto Iwata at the Department of Neurology, Tokyo Women\u27s Medical University)

Hypertension is a common early finding in patients with acute ischemic stroke. Although there is no definitive data from controlled clinical trials, the general consensus is that lowering blood pressure (BP) during the acute phase should not be done unless the patient has excessive hypertension (> 220/120 mmHg), there is a need for urgent antihypertensive treatment, such as aortic dissection, or the patient requires preparation for thrombolytic treatment. Aggressive BP treatment during the acute phase may lessen the risk of hemorrhagic transformation or further hypertensive organ damage, and forestall early recurrent stroke. In contrast, antihypertensive treatment may lead to neurological worsening due to reduced regional cerebral blood flow at the ischemic penumbra. Several small studies of aggressive antihypertensive treatment for acute ischemic stroke have shown neutral, adverse, or favorable outcomes. A large randomized controlled trial (the ACCESS study) has shown that the early use of an angiotensin II type 1 receptor blocking (ARE) agent, candesartan cilexetil, in acute ischemic stroke reduced long-term cardiovascular morbidity and mortality, even though no significant difference in BP levels was found between the candesartan- and placebo-treated groups. The BP-independent effects of ARBs may be beneficial for managing hypertension in patients with acute ischemic stroke.神経内科学教室岩田誠教授退任記念特別