How to manage blood pressure in critically ill neurologic patients

Changes in blood pressure (BP) are frequently encountered in patients who have neurologic injury from a variety of causes. Brain injury results in pathologic derangements in cerebral blood flow (CBF), autoregulation, and intracranial pressure (ICP) that may lead to secondary ischemic brain injury. The overriding principle in the management of BP in patients who have brain injury is to reduce systemic BP while maintaining adequate CBF. β-Adrenergic blocking drugs are the antihypertensive agents of choice in brain-injured patients because of their minimal effect on ICP. Vasopressor agents have been used in patients with symptomatic vasospasm following aneurysmal subarachnoid hemorrhage. More recently, the use of vasopressor agents has been extended to ischemic stroke.