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European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage

The optimal blood pressure (BP) management in acute ischaemic stroke (AIS) and acute intracerebral haemorrhage (ICH) remains controversial. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist physicians in their clinical decisions regarding BP managem...

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Autores principales: Sandset, Else Charlotte, Anderson, Craig S, Bath, Philip M, Christensen, Hanne, Fischer, Urs, Gąsecki, Dariusz, Lal, Avtar, Manning, Lisa S, Sacco, Simona, Steiner, Thorsten, Tsivgoulis, Georgios
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8370067/
https://www.ncbi.nlm.nih.gov/pubmed/34780579
http://dx.doi.org/10.1177/23969873211026998
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author Sandset, Else Charlotte
Anderson, Craig S
Bath, Philip M
Christensen, Hanne
Fischer, Urs
Gąsecki, Dariusz
Lal, Avtar
Manning, Lisa S
Sacco, Simona
Steiner, Thorsten
Tsivgoulis, Georgios
author_facet Sandset, Else Charlotte
Anderson, Craig S
Bath, Philip M
Christensen, Hanne
Fischer, Urs
Gąsecki, Dariusz
Lal, Avtar
Manning, Lisa S
Sacco, Simona
Steiner, Thorsten
Tsivgoulis, Georgios
author_sort Sandset, Else Charlotte
collection PubMed
description The optimal blood pressure (BP) management in acute ischaemic stroke (AIS) and acute intracerebral haemorrhage (ICH) remains controversial. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist physicians in their clinical decisions regarding BP management in acute stroke. The guidelines were developed according to the ESO standard operating procedure and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations based on the GRADE approach. Despite several large randomised-controlled clinical trials, quality of evidence is generally low due to inconsistent results of the effect of blood pressure lowering in AIS. We recommend early and modest blood pressure control (avoiding blood pressure levels >180/105 mm Hg) in AIS patients undergoing reperfusion therapies. There is more high-quality randomised evidence for BP lowering in acute ICH, where intensive blood pressure lowering is recommended rapidly after hospital presentation with the intent to improve recovery by reducing haematoma expansion. These guidelines provide further recommendations on blood pressure thresholds and for specific patient subgroups. There is ongoing uncertainty regarding the most appropriate blood pressure management in AIS and ICH. Future randomised-controlled clinical trials are needed to inform decision making on thresholds, timing and strategy of blood pressure lowering in different acute stroke patient subgroups.
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spelling pubmed-83700672021-08-18 European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage Sandset, Else Charlotte Anderson, Craig S Bath, Philip M Christensen, Hanne Fischer, Urs Gąsecki, Dariusz Lal, Avtar Manning, Lisa S Sacco, Simona Steiner, Thorsten Tsivgoulis, Georgios Eur Stroke J Guidelines The optimal blood pressure (BP) management in acute ischaemic stroke (AIS) and acute intracerebral haemorrhage (ICH) remains controversial. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist physicians in their clinical decisions regarding BP management in acute stroke. The guidelines were developed according to the ESO standard operating procedure and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations based on the GRADE approach. Despite several large randomised-controlled clinical trials, quality of evidence is generally low due to inconsistent results of the effect of blood pressure lowering in AIS. We recommend early and modest blood pressure control (avoiding blood pressure levels >180/105 mm Hg) in AIS patients undergoing reperfusion therapies. There is more high-quality randomised evidence for BP lowering in acute ICH, where intensive blood pressure lowering is recommended rapidly after hospital presentation with the intent to improve recovery by reducing haematoma expansion. These guidelines provide further recommendations on blood pressure thresholds and for specific patient subgroups. There is ongoing uncertainty regarding the most appropriate blood pressure management in AIS and ICH. Future randomised-controlled clinical trials are needed to inform decision making on thresholds, timing and strategy of blood pressure lowering in different acute stroke patient subgroups. SAGE Publications 2021-06-18 2021-06 /pmc/articles/PMC8370067/ /pubmed/34780579 http://dx.doi.org/10.1177/23969873211026998 Text en © European Stroke Organisation 2021 https://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Guidelines
Sandset, Else Charlotte
Anderson, Craig S
Bath, Philip M
Christensen, Hanne
Fischer, Urs
Gąsecki, Dariusz
Lal, Avtar
Manning, Lisa S
Sacco, Simona
Steiner, Thorsten
Tsivgoulis, Georgios
European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage
title European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage
title_full European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage
title_fullStr European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage
title_full_unstemmed European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage
title_short European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage
title_sort european stroke organisation (eso) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage
topic Guidelines
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8370067/
https://www.ncbi.nlm.nih.gov/pubmed/34780579
http://dx.doi.org/10.1177/23969873211026998
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