Pengendalian hipertensi sebagai faktor risiko stroke dan manajemen hipertensi pada penderita stroke akut

Stroke is a leading cause of death and disability worldwide. Stroke also exacts an enormous financial burden. It is estimated that annual direct and indirect costs for stroke care total $40 billion. Although stroke remains a leading cause of death, disability, and health care expenditures, it can be prevented. Several conditions and lifestyle factors have been identified as risk factors for stroke. These including hypertension, myocardial infarction, aridal fibrillation, diabetes mellitus, bloods lipids, asymptomatic carotid artery disease, cigarette smoking, alcohol use, physical activity and diet. Hypertension is the most powerful, prevalent, and treatable risk factor for stroke. In United States,hypertension was uncontrolled in 78% of ischemic stroke cases, 85% of hemorrhagic stroke cases. In Indonesia, hypertension was uncontrolled in 95.9% of ischemic and hemorrhagic stroke cases. Uncontrolled hypertension is strongly associated with stroke. A meta-analysis found a 42% reduction in stroke incidence with treatment, although the average blood pressure reduction was only 6 mmHg. Treatment of older patients with isolated systolic hypertension also reduced stroke by 36%. Treatment of hypertension in acute stroke, however more controversial and is the focus of this paper. There are no randomized trials that data to support guidelines for treatment of blood pressure in acute stroke patients. Previous guidelines have been based on clinical observations, clinical studies of the autoregulation of the cerebral blood flow in humans and animals, animal models of acute stroke, and current concepts concerning the pathophysiology of focal brain ischemia. Guidelines for treatment of blood pressure in the setting of ischemic stroke, intracerebral hemorrhagic stroke, and subarachnoid hemorrhagic stroke have been proposed by Broderick in a National Symposium on Rapid Identification and Treatment of Acute Stroke (December 12-13, 1996). Key words: hypertension - acute stroke - primary prevention-treatment - autoregulatio