General management of elevated blood pressure, blood glucose and body temperature
Monitoring the blood pressure (BP), glucose levels and temperature in acute stroke patients is an often neglected matter although it may have an important impact upon the patients' outcome. In the Tel Aviv stroke register, recorded between the years 2001 and 2003, 32% of acute stroke patients in the emergency room had glucose levels higher than 150 mg/dl, higher systolic BP than 140 mmHg was found in 77% of the patients and 17% of patients had temperatures above 37°C on admission. These numbers are representative of other centers as well. This chapter will summarize the current knowledge regarding the management of the above.
Hypertensive blood pressure values in acute ischemic stroke
Several observations have demonstrated spontaneous elevation of blood pressure in the first 24–48 hrs after stroke onset with a significant spontaneous decline after a few days [1–3]. Several mechanisms may be responsible for the increased blood pressure, including stress, pain, urinary retention, Cushing effect due to increased intracranial pressure and the activation of the sympathetic, renin–angiotensin and ACTH– cortisol pathways. Despite the increased prevalence of hypertension following stroke, optimal management has not been yet established. Several arguments speak for lowering the elevated BP: risks of hemorrhagic transformation, cerebral edema, recurrence of stroke and hypertensive encephalopathy.