Stroke patient blood pressure

[ReeseW]

I'm a newbie in the ICU & was wondering if anyone can explain to me the rationale behind maintaining a stroke patient's b/p on the high side?

My preceptor informed me that my patient's systolic b/p should be maintained >150. My fear was that too high of a b/p could cause another stroke for this patient! Any good websites that may have the answer?

Thanks for your time!

[Advocate1]

I'm pretty sure that the BP needs to be on the high side to ensure perfusion to the brain-

If I'm worng feel free to correct me

[VivaLasViejas, ASN, RN]

That is exactly why the BP needs to stay up (although not in the 'red zone'). If you lower BP too much and/or too fast, it reduces perfusion to the brain and actually extends the damage caused by the CVA.

An MD explained that to me back when this thinking was still new. I've never forgotten that. Now you won't either.

[Christie RN2006]

It all depends on what caused the stroke. With some types of strokes you do want to keep their pressure a little bit higher to make sure the brain is being adequately perfused. With certain types of strokes such as certain hemorrhagic strokes, you want to keep their BP lower (normally we keep the SBP below 140) because you don't want them to bleed anymore. You need to get orders from the doc as to where they want the BP to be and what they want you to do to meet the target BP.

[cuppwk01]

Right, with infarction, you want the blood to get pushed into all the nooks and crannies of the brain, through the blockages, so you need some force behind it. In hemorrhage, you basically have a leaky dam, too much pressure is going to blow it out.

[texasneuroRN]

The area around the infarct is called the Penumbra. This is an area of decreased perfursion (ischemia) that has the ability to become infarcted if not well perfused. Patients will often have increased blood pressure following a stroke. This is thougth to be a protective mechanism. If the patient does not receive t-Pa, it is considered acceptable to let the systolic ride up to 220mm/hg. Reducing the blood pressure from over 220mm/hg to less than 185mm/hg to give t-Pa causes more harm than not administering the t-Pa. Patients with subarachnoid hemorrhage post clipping or coiling also need their systolic blood pressure high to prevent vasospasms which lead to stroke. The American Stroke Association and The American Heart Association websites both have a lot of free resources regarding stroke. Joanne Hickey's book and the AANN book are also very good resources for stroke information.

[ReeseW]

Thank you to all who have taken time to reply to my question! Thank you texasneurorn for the website references! Glad to be a part of this online community