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Updated: Nov 21, 2025
Real-Time Monitoring and Modulation of Blood Pressure in a Rabbit Model of Ischemic Stroke
Published on: February 10, 2023
Management of blood pressure in stroke
Philip B Gorelick1,2, Shakaib Qureshi3, Muhammad U Farooq3
1Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Insights
Blood pressure targets for stroke management differ based on stroke type and stage. Controlling blood pressure variability is crucial, especially in acute stroke phases, for better long-term outcomes.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Blood pressure (BP) management is critical in stroke care.
- Recent US-based guidance offers updated recommendations for BP control in various stroke types and stages.
Purpose of the Study:
- To review and discuss recent US-based guidance statements on BP management in stroke.
- To outline BP targets according to stroke type and stage.
Main Methods:
- Review of recent guidance statements from US organizations like the American Heart Association/American Stroke Association and American College of Cardiology.
- Inclusion of relevant articles available to the authors.
Main Results:
- Key BP target before alteplase (t-PA) is <185/110 mm Hg; maintenance BP post-tPA is <180/105 mm Hg.
- For intracerebral hemorrhage (IPH), acute lowering to 140 mm Hg systolic is safe if BP is between 150-220 mm Hg.
- For small vessel ischemia, target systolic BP is <130 mm Hg; for primary/recurrent stroke prevention, targets are <140/90 mm Hg or <130/80 mm Hg.
- BP control may help prevent cognitive decline.
Conclusions:
- Stroke BP management targets are dynamic, varying by stroke subtype and chronological stage.
- Controlling BP variability, particularly in acute stroke, is important for long-term outcomes.
Objective:
In this review and opinion piece, we discuss recent United States (US)-based guidance statements on the management of BP in stroke according to stroke type and stage of stroke.
Methods:
We reviewed the most recent guidance statements on BP control from United States (US)-based organizations such as the American Heart Association/American Stroke Association (AHA/ASA) and American College of Cardiology (ACC), and articles available to the authors in their personal files.
Results:
The key BP target before starting alteplase (t-PA) is < 185/110 mm Hg, and the maintenance BP after tPA administration is < 180/105 mm Hg. For IPH patients with systolic BP between 150 and 220 mm Hg and no contraindication to acute BP reduction therapy, acute lowering to 140 mm Hg systolic BP is safe. For persons with small vessel or lacunar cerebral ischemia, a reasonable BP lowering target is < 130 mm Hg systolic. For primary stroke prevention, the target BP for those with hypertension is < 140/90 mm Hg and self-measured BP is recommended to assist in BP control. Recent study and guidance suggest a BP target of <130/80 mm Hg for both primary and recurrent stroke prevention. BP control is reasonable for the prevention of cognitive decline or dementia.
Conclusions:
BP targets for the proper management of stroke vary by chronological stage of stroke and by stroke subtype. Furthermore, consideration should be given to control of BP variability, especially in the acute phases of stroke, as it may play a role in conferring longer term outcomes.
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