[Hypertension in the acute phase and in the secondary prevention of stroke]

Elevated blood pressure (BP) is frequent after acute stroke and almost 40% of patients remain hypertensive over a period of about a week. There is no data from controlled trials concerning management of hypertension in the acute phase of stroke. Theorical beneficial effects of acutely lowering BP seems lower that risk of deterioration of ischemic brain tissue. Current acute ischemic stroke guidelines suggest that unless systolic BP exceeds an cutoff of 220 mmHg or diastolic exceeds 120 mmHq, it should be tolerated, except in planned thrombolytic therapy. In case of hemorragic stroke, the cutoff should be of 185/110 mmHg. Prudence suggests that BP should be lowered carefully. In secondary prevention of stroke, the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) demonstrated that a blood pressure-lowering regimen, involving a angiotensin-converting enzyme inhibitor and a diuretic, reduced the risks of stroke of 28% and of other major vascular events of 26% among individuals with a history of cerebrovascular disease. Every patient with a history of stroke should be treated with the association.