PEDOMAN PENGELOLAAN HIPERTENSI PADA AKUT STROKE 2011 by Hasan Sjahrir Untuk stroke iskemik akut: 1.

Beta blockers are not as effective as other antihypertensive drugs in reducing stroke /recurrent 2. Large fall and increase blood pressures during the acute phase of stroke are associated with a poor outcome 1. SBP >180 mm Hg doubled the risk of poor outcomes (lost cerebral autoregulation, cerebral oedema) 2. SBP < 136 mm Hg increased the risk of poor outcomes by 30%.(reduction perfussion pressure) 3. Anti HT agents should be give: the DBP is >120mmHg or the SBPis > 220 mm Hg and limiting the drop in BP during the first 24 hours by approximately 15%. 4. BP-lowering therapy as soon as 6 - 24 hours after acute ischemic stroke 5. IV thrombolytic tx: BP should be lowered if > 185 mm Hg systolic or >110 mm Hg diastolic. After thrombolytic tx, SBP should be kept <180 mm Hg and DBP < 105 mm Hg. 6. There are anti-HT drugs (Thiazide diuretics, ACEi, ARBs, -blockers, CCB) single or combination, but some studies have suggested ACEi and ARBs may be more effective in recurrent stroke prevention than other anti HT 7. two weeks after the onset of acute stroke symptoms, SBP should be a goal of <140 mm Hg and diastolic BP to <90 mm Hg are associated with a lower risk of stroke and cardiovascular events (Class I; Level A). DM or renal disease, the BP goal is <130/80 mm Hg (Class I; Level A). untuk stroke haemorrhagis: 1. a systolic BP of >150 mm Hg, acute lowering of systolic BP to 140 mm Hg is probably safe, the goal target of less than 140/90 or less than 130/80 mm Hg for diabetes or kidney disease is "reasonable. the BP pressure target, duration of therapy, and whether such treatment improves clinical outcomes remain unclear. 2. systolic BP above 140 mmHg within 12 hours of ICH is associated with more than double the risk of subsequent death or dependency 3. HT could contribute to hydrostatic expansion of the hematoma, peri-hematoma edema, and rebleeding. High BP during acute stroke aggravates cerebral edema. 4. early intensive blood pressure reduction is clinically feasible, well tolerated, and may reduce hematoma expansion in ICH, The relative risk of hematoma expansion was 36% lower (95% confidence interval 0-59%, P = 0.05) 5. surgery indication: In terms of clot removal, that for most patients with ICH, the usefulness of surgery is "uncertain." ii) Pts with cerebellar hemorrhage who are deteriorating neurologically or brainstem compression and/or hydrocephalus surgical removal of the hemorrhage as soon as possible.(CLASS 1) iii) Initial th/ of pts with ventricular drainage alone rather than surgical removal is not recommended (CLASS III) iv) For patients presenting with lobar clots of more than 30 mL and within 1 cm of the surface, evacuation of supratentorial ICH by standard craniotomy might be considered (CLASS IIb) i)