My patient, a 63 year-old Malay gentleman with underlying hypertension and hyperlipidaemia, presented with sudden onset of left-sided body weakness. Physical examination showed signs of upper motor neuron lesion, such as hypertonia, muscle power 1/5, hyperreflexia, positive ankle clonus and positive Babinski sign. CT brain scan confirmed the diagnosis of acute ischaemic stroke as it showed infarction at right frontal lobe with underlying cerebral atrophy.
Diagnosis: Acute Ischaemic Stroke with left-sided hemiparesis, with underlying hypertension and hyperlipidaemia
During admission, his blood pressure was 148/80mmHg. The patient was given tablet Amlodipine 5mg OD on the first day but withheld on the second day on the second day of admission.
Blood Pressure Control
In poor flow state as occurs with thrombotic ischaemic stroke, the cerebral vasculature is without vasoregulatory capability and thus relies directly on mean arterial pressure (MAP) to maintain cerebral blood flow. Therefore, aggressive efforts to lower blood pressure may decrease perfusion pressure and may worsen ischaemia.
I think this patient should not be given Amlodipine as his blood pressure was not high during admission. Antihypertensive agent may worsen cerebral ischaemia in acute ischaemic stroke.
Therefore, antihypertensive agent should only be given 2 weeks after the event.
What would the appropriate blood pressure control in this case?
I agree with you that we should not prescribe any antihypertensive drug at this stage.
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