Circulation

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Hypotension is relatively uncommon in stroke patients; if it does occur, it is usually secondary to coexistent heart disease (arrhythmias, heart failure, or acute myocardial infarction), dehydration, or sepsis. As cerebral autoregulation is disturbed following stroke, with the result that cerebral blood flow becomes directly dependent upon systemic blood pressure, urgent correction is required. By contrast, hypertension is extremely common following stroke, even in patients without pre-existing hypertension.40,41 Although some authorities recommend early pharmacological lowering of raised blood pressure, given the current absence of any convincing evidence of the effectiveness of such a policy42-45 and the recognised potential dangers of hypotension,46 we only give hypotensive drugs early (within the first 72 hours) to patients with features of accelerated hypertension or hypertensive encephalopathy or acute aortic dissection. We usually continue any previous antihypertensive medication a patient may have been taking, provided they are not hypotensive and can safely swallow the tablets. There is uncertainty about when hypotensive drugs should be started after the acute phase; in many cases an elevated blood pressure falls spontaneously in the days following an acute stroke. We usually delay consideration of long term drug therapy for at least a week, although we acknowledge that some physicians would start therapy earlier. Further trials assessing the effect of lowering blood pressure in acute stroke are under way (see www.nottingham.ac.uk/stroke-medicine/enostrialdb/ or www.le.ac.uk/me/shg2/COSSACShome.html).

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Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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