Sun21November0420PM 8

A 63-year-old man with a history of type 2 diabetes and hypertension is admitted to the Emergency Department some five hours after suffering weakness affecting the right hand side of his face and his right arm.

On initial assessment, you confirm the obvious weakness, and it is apparent the patient has suffered an acute stroke.

In this situation systolic blood pressure above what level would require acute treatment?

(Please select 1 option)

200 mmHg

180 mmHg

160 mmHg

140 mmHg

220 mmHg Correct

Explanation

The correct answer is 220 mmHg. Unlike haemorrhagic stroke, where lower systolic blood pressure is targeted, in ischaemic stroke, only BP of >220/120 mmHg merits acute intervention.

At blood pressures of lower than 220/120 mmHg there is no evidence of benefit for acute blood pressure lowering. Trials have looked at active intervention on top of patients existing medication or continuing existing anti-hypertensives, and those trials have either shown no benefit or potential harm, (for example a 2014 meta-analysis suggested increased 30-day mortality).

Labetolol and nicardipine are the usual first line agents for lowering blood pressure. Nitroprusside is generally considered a second line option because it theoretically may increase intracranial pressure or impair platelet function.

Answer Statistics

1

19%

2

38%

3

9%

4

2%

5

34%

Times answered: 278