Suspected stroke and high blood pressure in patients transported by EMS

A patient with suspected stroke transported by the emergency medical services is expected to have high blood pressure. What is the threshold value that warrants attempts to lower blood pressure by the ambulance crew?

Wieslaw Oczkowski: Treating blood pressure in somebody who has a stroke or possible stroke is not straightforward. It always depends on what the stroke etiology is. For example, the blood pressure thresholds for people with ischemic stroke are different than the blood pressure thresholds for people with hemorrhagic stroke, and the blood pressure thresholds are different if there is a potential that the individual may be treated with thrombolysis. For example, there are specific guidelines for treatment of blood pressure for thrombolysis patients, while if somebody has a strokelike syndrome and the stroke is known to be ischemic, the blood pressure treatment is relatively lax in terms of what we call permissive hypertension. We actually allow the individual to have relative hypertension to prevent the risk of cerebral ischemia due to lowering of the blood pressure too much.

The other scenario which comes up is if somebody has a hemorrhagic stroke. So, once you have done the computed tomography (CT) scan, you identified that they have actually had a hemorrhagic stroke, then the blood pressure thresholds are lower than those of ischemic stroke.

In general, the management of hypertension for somebody with a presumed stroke is very dependent on what the individual may receive and also very dependent on what type of stroke the individual may have suffered.