Induced elevation of blood pressure in the acute phase of ischemic stroke in humans.

To the Editor: Blood pressure is often elevated in the acute phase of stroke. Possible reasons are previous hypertension, a pathophysiological response to ensure perfusion in the ischemic penumbra, or a reaction to the stress of hospitalization. The course of blood pressure following an acute stroke has been extensively studied and shows a spontaneous decline during the first week.1 2 3 4 5 Decreasing the blood pressure in the acute phase of stroke can have a deleterious effect on outcome.6 7 The consensus is not to treat high blood pressure during the first week, except for a consistently elevated systolic blood pressure >250 mm Hg or diastolic blood pressure >140 mm Hg.8 9 The safety and efficacy of increasing blood pressure is completely unknown. The rationale for this therapy is that it may help to restore the blood flow to the ischemic area of which the perfusion is passively dependent on the systemic blood pressure because of the loss of local autoregulation, or it may induce dilatation of the leptomeningeal collateral circulation in case of an embolic occlusion. Early reports in humans10 11 and recent experimental work12 13 have shown a beneficial effect on outcome of treatment with induced hypertension.14 15 In animal stroke models, diaspirin cross-linked hemoglobin (DCLHb), a purified cell-free human oxygen-carrying …