Hypertension Blog

Treatment of a patient who has had a cerebrovascular event may involve drug therapy and surgery.

If your hypertensive patient has experienced an ischemic or hemorrhagic eVA, the physician may prescribe an antihypertensive drug to lower his blood pressure. However, if elevated Iep results from a hemorrhagic eVA, his blood pressure shouldn’t be reduced too quickly or too much.

The physician may prescribe heparin I.V. to treat TlAs and ischemic eVAs, but not to treat hemorrhagic eVAs because it increases the risk of bleeding. If heparin is administered for a TIA or an ischemic eVA, titrate the drug to maintain the PTT at about twice the normal level. Once your patient’s PTT has reached this therapeutic level, the physician may prescribe warfarin, which is taken orally. Typically, heparin therapy continues until the warfarin brings the prothrombin time to a therapeutic level.

If the patient has experienced an ischemic eVA, the physician may prescribe recombinant t-PA to disintegrate the thrombus or embolus that’s causing the occlusion .

A physician also may prescribe a drug that prevents platelet aggregation, such as aspirin, dipyridamole, or ticlopidine hydrochloride, to prevent thrombus and embolus formation and to treat an ischemic CVA.

After the patient has been stabilized, the physician may use drug therapy to minimize disability. Typically, he’ll prescribe mannitol I.V. to reduce cerebral edema. This drug draws fluid out of the extravascular space and into the vascular system.

If the patient has a large hematoma displacing a considerable amount of surrounding tissue or if drug therapy fails to lower his elevated ICP, he may require a craniotomy to remove the hematoma and relieve pressure.

A surgeon may perform an endarterectomy to reduce the risk of future TIAs or a CVA. This procedure removes atherosclerotic plaque that’s obstructing blood flow to the brain. Commonly, endarterectomies are performed on the common carotid bifurcation and the arch of the aorta.

If the surgeon can’t remove the obstruction causing an ischemic CVA, he may perform an extracranial-intracranial bypass. This procedure involves bypassing the intracranial artery just beyond the obstruction with an extracranial artery, thus restoring blood flow.