Relationship Hypertension And Stroke

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Stroke is a complication of hypertension, where most dihubungankan directly with the level of blood pressure (Zhang et al., 2006). Hypertension drug administration actually is a problem, because the drop in blood pressure is needed to prevent further organ damage, but on the other hand, administration of antihypertensive drugs are also at risk of rapid decline in blood pressure, which is very harmful to the perfusion (blood flow) to the brain. Therefore, antihypertensive drugs are not given to normalize blood pressure, but only reduce blood pressure to a certain extent appropriate treatment protocol (Karyadib, 2002).

Blood pressure often increases during the period of post-stroke and a few compensating physiological response to change into ischemic cerebral perfusion in the lining of the brain. The result of blood pressure therapy to reduce or block the acute brain damage until clinical condition is stable (Chobanian et al., 2004).

a. Pathophysiology

Hypertension is a potential risk factor for stroke. Hypertension can lead to rupture or narrowing of the blood vessels of the brain. When the brain's blood vessels rupture there arose a brain hemorrhage and when the brain's blood vessels constrict the blood flow to the brain is disrupted and brain cells will die. From various studies obtained clear evidence that good control of hypertension systolic, diastolic or both decrease the incidence of stroke (Harsono, 2005).

b. Therapeutic target

Blood pressure in the acute phase is slowly lowered because of the onset of reactive hypertension and most will go down alone on days 3 to 7 (Iskandar, 2003). Decrease in blood pressure in ischemic stroke may be considered if the systolic blood pressure> 220 mmHg or diastolic> 120 mmHg, blood pressure reduction should be around 10-15% with the blood pressure monitoring (Adams et al, 2003), whereas the bleeding stroke may be reduced if systolic blood pressure of patients = 180mmHg or diastolic blood pressure> 130mmHg (Broderick et al, 2007).

Relationship Hypertension And Stroke

c. Management of hypertension in ischemic stroke

Management of hypertension in ischemic stroke is the class of antihypertensive medications alpha beta blockers (labetalol), ACE inhibitors (captopril, or the like) or a calcium antagonist that works peripheral (nifedipine or the like) decrease in blood pressure in acute ischemic stroke may only be a maximum of 20% of blood pressure before. Sublingual nifedipine should be given with caution and with strict monitoring of blood pressure every 15 minutes or by means of continuous monitoring of blood because it can decrease drastically, so it should be started at a dose of 5 mg sublingual and can be increased to 10mg depending on previous responses.

Blood pressure that is difficult to be lowered by the aforementioned drugs or when diastolic> 140mmHg persistently then it should be given intravenous sodium nitroprusside 50mg / 250ml dextrose 5% in water (200mg / ml) at a speed of 3ml / h (10 mg / min) and titrated to blood pressure desired. Another alternative may be given nitroglycerin drips 10-20μg / min. Low blood pressure in acute stroke is not common. Where the blood pressure should be raised with dopamine or dobutamine drips and treat the underlying cause (Mansjoer et al, 2007).

d. Management of hypertension in haemorrhagic stroke

Management of hypertension in hemorrhagic stroke as opposed to acute cerebral infarction, blood pressure control approaches that are more aggressive in patients with acute intracerebral hemorrhage, due to the high pressure can cause a worsening of edema perihematom and increase the likelihood of rebleeding.

Blood pressure> 180mmHg should be lowered to 150-180mmHg with labetalol (20mg intravenously in minutes), on repeat administration of 40-80mg intravenous labetalol in 10-minute intervals until the desired pressure, then infusion of 2 mg / min (120 ml / min) and titrated or ACE inhibitors (eg, captopril 12,5-25mg, 2-3 times daily) or calcium antagonists (eg nifedipine 10 mg orally 3 times) (Mansjoeret al, 2007).

e. Preventive therapy

Maintenance of blood pressure targets in patients who have a stroke are the main capital to mitigate the risk of a second stroke (Saseen and Carter, 2005). Approximately 5% of patients treated with ischemic stroke suffered a second stroke within the first 30 days (Mansjoer et al, 2007).

Source: Intan Mustika Sari FFUMS 2009