Management of Cerebral Infarction or Transient Ischemic Attacks

Abstract

<i>To the Editor</i>.— Two statements in the recent report by "The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure"1 give cause for concern, with respect to neurological patients. The first is that following acute ischemic cerebral infarction or transient ischemic attacks, "antihypertensive therapy may be withheld temporarily to avoid critical reduction in cerebral perfusion unless the diastolic blood pressure is very high (greater than 105 mm Hg)." The article gives no guidelines regarding how and to what degree the blood pressure should be lowered. In my experience, many physicians arbitrarily "normalize" the blood pressure to about 120/80 mm Hg or even lower, probably because treatment of chronic hypertension (diastolic pressure greater than 105 mm Hg) reduces the incidence of stroke in the long term. Patients with acute stroke usually have had chronic hypertension, often untreated, and consequently have higher limits of cerebral autoregulation than normal.