Problems Related to Short-Term Antihypertensive Therapy in Acute Ischemic Stroke

Hypertension is a common early finding after an acute ischemic stroke, even in previously normotensive patients. But its significance and proper management are a matter of debate, because of the lack of adequately powered randomized clinical trials. A close analysis of observational and interventional trials, published so far, fails to convince that an early antihypertensive therapy is needed and beneficial. During the first 24–48 hr after ischemic stroke, only blood pressure values repeatedly higher than 220/120 mmHg require antihypertensive treatment to keep blood pressure levels in the range of 180–220 mmHg systolic and 100–120 diastolic. Blood pressure reduction should be cautious with the aim of keeping the pressure at relatively high values (180/100–105 in previously hypertensive patients and 160–180/90–100 in previously normotensive patients). The usefulness of increasing blood pressure with vasopressive agents in selected patients with ischemic stroke deserves adequate testing with randomized clinical trials.