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Blood pressure treatment in acute ischemic stroke: a review of studies and recommendations

Ntaios, Georgea; Bath, Philipb; Michel, Patrika

doi: 10.1097/WCO.0b013e328334e9d9
Cerebrovascular disease: Edited by Patrik Michel

Purpose of review Elevated blood pressure (BP) is frequent in patients with acute ischemic stroke. Pathophysiological data support its usefulness to maintain adequate perfusion of the ischemic penumba. This review article aims to summarize the available evidence from clinical studies that examined the prognostic role of BP during the acute phase of ischemic stroke and intervention studies that assessed the efficacy of active BP alteration.

Recent findings We found 34 observational studies (33 470 patients), with results being inconsistent among the studies; most studies reported a negative association between increased levels of BP and clinical outcome, whereas a few studies showed clinical improvement with higher BP levels, clinical deterioration with decreased BP, or no association at all. Similarly, the conclusions drawn by the 18 intervention studies included in this review (1637 patients) were also heterogeneous. Very recent clinical data suggest a possible beneficial effect of early treatment with some antihypertensives on late clinical outcome.

Summary Observational and interventional studies of management of acute poststroke hypertension yield conflicting results. We discuss different explanations that may account for this and discuss the current guidelines and pathophysiological considerations for the management of acute poststroke hypertension.

aNeurology Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland

bStroke Trials Unit, Institute of Neuroscience, University of Nottingham, Nottingham, UK

Correspondence to George Ntaios, MD, Neurology Service, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.