Antihypertensive therapy in acute ischemic stroke: where do we stand?

Area of Science:

• Neurology
• Cardiology
• Clinical Trials

Background:

• Strict blood pressure (BP) control benefits stroke prevention but its management in acute stroke is debated.
• Elevated BP in ischemic stroke is linked to adverse events and mortality, yet BP-lowering offers no clear survival benefit.

Purpose of the Study:

• To review randomized trials and meta-analyses on managing hypertension in acute ischemic stroke.
• To discuss uncertainties and future research directions in acute stroke BP management.

Main Methods:

• Systematic review of randomized controlled trials and meta-analyses.
• Analysis of observational studies on BP and stroke outcomes.
• Discussion of current guidelines and clinical trial data.

Main Results:

• Antihypertensive therapy in acute ischemic stroke effectively lowers BP but doesn't improve death or dependency risk.
• Recommended BP thresholds for intervention in acute ischemic stroke are >220/120 mmHg, or >185/110 mmHg for thrombolysis candidates.
• Intensive BP lowering (<140 mmHg systolic) is safe and reduces hematoma expansion in acute intracerebral hemorrhage.

Conclusions:

• Avoid aggressive BP lowering in the early phase of ischemic stroke.
• Specific BP thresholds guide antihypertensive therapy in acute ischemic stroke.
• Intensive BP control is beneficial for acute intracerebral hemorrhage, reducing hematoma expansion.