This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related article  • Related letter  • Similar articles in this journal  Topic Collections  • Cerebrovascular Disease  • Cardiovascular System, Other  • Stroke  • Cardiovascular System  • Surgery  • Drug Therapy  • Drug Therapy, Other  • Hypertension  • Alert me on articles by topic  Social Bookmarking   What's this?

Sheryl Martin-Schild, MD, PhD

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In reply

My coauthors and I thank Dr Slosberg for his important comments. Lowering BP in the setting of ischemic stroke may pose harm to the penumbra. Elevated BP on reperfusion could also be harmful by predisposing to hemorrhagic conversion and promoting edema. When patients are being considered for revascularization in the setting of acute ischemic stroke but have BPs exceeding recommended guidelines, our choices include lowering the BP to treat with tissue plasminogen activator (tPA) or not lowering BP and withholding tPA. Guidelines on tPA protocol call for BP lowering to less than 185/110 mm Hg prior to treatment,¹ but little data regarding the safety and outcomes in such cases exist.

Our study was retrospective; therefore, there was no formal protocol for BP lowering before tPA was administered other than that the BP must be less than 185/110 mm Hg to be in compliance with . . . [Full Text of this Article]

AUTHOR INFORMATION



CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Aggressive Blood Pressure–Lowering Treatment Before Intravenous Tissue Plasminogen Activator Therapy in Acute Ischemic Stroke
Sheryl Martin-Schild, Hen Hallevi, Karen C. Albright, Aslam M. Khaja, Andrew D. Barreto, Nicole R. Gonzales, James C. Grotta, and Sean I. Savitz
Arch Neurol. 2008;65(9):1174-1178.
ABSTRACT | FULL TEXT  

RELATED LETTER

Aggressive Blood Pressure Lowering in Acute Ischemic Stroke
Paul S. Slosberg
Arch Neurol. 2009;66(6):804.
EXTRACT | FULL TEXT