Hazards of Therapy for Excessive Hypertension in Acute Stroke

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Abstract
Six cases with acute onset of neurological symptoms and extremely high blood pressure (BP) are reviewed. Hypertensive crisis or stroke were the main differential diagnoses. According to what is advocated for both situations, prompt antihypertensive therapy was instituted. Although recommended doses of hydralazine, reserpine or furosemide were given, the systolic BP fell to < 100 mmHg. Intracerebral hemorrhage or infarction was subsequently established in all patients and only 1 survived. Convincing evidence for a beneficial effect of BP reduction in acute stroke is lacking. Excessive response to therapy was seen in some patients. Moderate lowering of BP might reduce cerebral blood flow in these patients, often chronically hypertensive and with raised intracranial pressure. Extreme caution with antihypertensive therapy seems warranted if the diagnosis of hypertensive crisis is not certain and a stroke is suspected.