Difference between revisions of "Template:ICH Hypertension Guidelines"

(/* AHA Aneurysmal SAH BP GuidelinesBederson J. et al. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Heart Association. Stroke. ...)
(/* AHA Aneurysmal SAH BP GuidelinesBederson J. et al. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Heart Association. Stroke. ...)
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===AHA Aneurysmal SAH BP Guidelines<ref>Bederson J. et al. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Heart Association. Stroke. 2009;40:994-1025 [http://stroke.ahajournals.org/content/40/3/994.full.pdf PDF]</ref>===
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{{AHA SAH BP Guidelines}}
#To date, no well-controlled studies exist that answer whether blood pressure control in acute Aneurysmal Subarachnoid Hemorrhage influences rebreeding.
 
#Blood pressure should be monitored and controlled to balance the risk of stroke, hypertension-related rebleeding, and maintenance of cerebral perfusion pressure (Class I, [[EBQ:Evidence_Levels|Level of Evidence B]]).
 
#Nicardipine, labetalol, and esmolol are appropriate choices for blood pressure control.  Sodium nitroprusside may raise intracranial pressure and cause toxicity with prolonged infusion and should be avoided.
 

Revision as of 01:16, 22 July 2014

AHA Spontaneous ICH BP Guidelines[1]

  1. If SBP is >200 mm Hg or MAP is >150 mm Hg, then consider aggressive reduction of BP with continuous intravenous infusion, with frequent BP monitoring every 5 min.
  2. If SBP is >180 mmHg or MAP is >130mm Hg and there is the possibility of elevated ICP, then consider monitoring ICP and reducing BP using intermittent or continuous intravenous medications while maintaining a cerebral perfusion pressure ≥60 mm Hg
  3. If SBP is >180 mmHg or MAP is >130 mmHg and there is not evidence of elevated ICP, then consider a modest reduction of BP (eg, MAP of 110 mm Hg or target BP of 160/90 mm Hg) using intermittent or continuous intravenous medications to control BP and clinically reexamine the patient every 15 min


AHA Aneurysmal SAH BP Guidelines[2]

  1. No well-controlled studies exist that answer whether BP control influences rebleeding
  2. BP should be controlled to balance the risk of stroke, hypertension-related rebleeding, and maintenance of cerebral perfusion pressure (Class I, Level of Evidence B).
  3. Nicardipine, labetalol, and esmolol are appropriate choices for BP control (Sodium nitroprusside may raise intracranial pressure and cause toxicity with prolonged infusion and should be avoided)
    1. Morgenstern, L. et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke 2010;41;2108-2129 PDF
    2. Bederson J. et al. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Heart Association. Stroke. 2009;40:994-1025 PDF