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Antihypertensive
treatment in Acute Ischemic Stroke
05 November 2004
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Blood
pressure
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Action
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1.
Systolic BP <210 mmHg or diastolic> 110 mmHg or both
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Do
not treat acutely but initiate long term agent slowly at day 3 after
stroke if remains hypertensive BP>140/90. Use ACE inhibitor such as
Coversyl plus, b
blocker (atenolol) or calcium antagonist (Norvasc)
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2
. Systolic BP >210 mmHg or diastolic>110 mmHg or both
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Captopril
drops sublingual/oral 5mg/ml 1-2 drops
OR
norvasc 5 mg
OR
Transiderm 25 patch
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3.
Hypertensive encephalopathy
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Infuse
sodium nitroprusside (0.5 to 10 mcg/kg/min).*
Labetalol
10 mg iv, maybe repeated with double dose after 10 min as needed to max
of 160 mg
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*
Use of continuous arterial monitoring is advised if sodium nitroprusside is
used. The risk of bleeding secondary to arterial puncture should be weighed
against the possibility of missing significant changes in pressure during the
infusion.
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