Treatment of Hypertension in Association with Stroke

Blood Pressure Management in Acute Ischaemic Stroke (Onset to 72 Hours)

1. For patients with ischemic stroke not eligible for thrombolytic therapy, hypertension in the setting of acute ischemic stroke or transient ischemic attack should not be routinely treated (Grade D; revised wording). Extreme blood pressure increases (e.g. systolic >220 mmHg or diastolic >120 mmHg) may be treated to reduce the blood pressure by approximately 15 percent (Grade D), and not more than 25%, over the first 24h with gradual reduction thereafter (Grade D). Avoid excessive lowering of blood pressure because this might exacerbate existing ischemia or might induce ischemia, particularly in the setting of intracranial or extracranial arterial occlusion or extra cranial carotid or vertebral artery occlusion (Grade D; revised wording). Pharmacological agents and routes of administration should be chosen to avoid precipitous decreases in blood pressure (Grade D).
2. For patients with ischemic stroke eligible for thrombolytic therapy, very high blood pressure (>185/110mmHg) should be treated concurrently with thrombolysis to reduce the risk of hemorrhagic transformation (Grade B; revised guideline). Blood pressure should be lowered to below 185/110 mm Hg prior to tPA therapy and to below 180/105 for the next 24 hours (Grade D; revised guideline).