Therapeutic hypertension: Principles and methods

David J. Powner, Joseph M. Darby, John W. Crommett, Robert L. Levine

Research output: Contribution to journalReview article

Abstract

The aspects of cardiovascular physiology important for the safe and effective implementation and titration of hypertensive therapy among neurosurgical patients with neurological or neurosurgical illness/injury are reviewed. Therapeutic hypertension may be an appropriate treatment for some neurological or neurosurgical conditions, e.g., vasospasm or support of cerebral perfusion pressure. Initiation and maintenance of hypertension should be done safely to avoid complications and/or undesired side effects. Accurate measurement of the arterial and central vascular pressures, the limitations of those methods, and alternative estimates of intravascular volume are reviewed. Hypertensive therapy is accomplished by modifying cardiac output and systemic vascular resistance, the principal physiological determinants of blood pressure. The goals of hypertensive therapy can be achieved by proper evaluation and manipulation of the four components of cardiac output, preload, afterload, heart rate and contractility. Measurement or calculation of estimates of these parameters is important in the selection of proper medications or supplemental fluid administration.

Original languageEnglish (US)
Pages (from-to)227-235
Number of pages9
JournalNeurosurgical Review
Volume27
Issue number4
DOIs
StatePublished - Oct 1 2004

Keywords

  • Brain edema
  • Brain injuries
  • Hemodynamics
  • Intracranial
  • Subarachnoid hemorrhage
  • Vasospasm

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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  • Cite this

    Powner, D. J., Darby, J. M., Crommett, J. W., & Levine, R. L. (2004). Therapeutic hypertension: Principles and methods. Neurosurgical Review, 27(4), 227-235. https://doi.org/10.1007/s10143-004-0343-8