Raised blood pressure is common in ischaemic stroke and intracerebral haemorrhage and is
an independent risk factor for unfavourable outcome. Yet, the approach to blood pressure
management represents an unresolved issue in acute stroke treatment. The aim of this review is to
present the current knowledge regarding the management of raised blood pressure in patients with
acute ischaemic stroke or intracerebral haemorrhage.
In ischaemic stroke, several large clinical trials have tested the efficacy of several strategies that lower blood pressure.
Overall, blood pressure lowering in the acute phase has no beneficial effect and should not be included in routine clinical
practice apart from when treating patients with very raised blood pressure or those who are eligible for thrombolytic
These findings in patients with acute ischaemic stroke are in contrast with those in intracerebral haemorrhage. A recent
clinical trial has strongly suggested a clinical benefit of blood pressure lowering during the first few hours in intracerebral
haemorrhage, which have led to changes in international guidelines.
An important unanswered question in blood pressure management in the acute phase of ischaemic stroke involves the first
few hours, when there is still penumbral tissue at risk. Forthcoming trials may help to answer this remaining issue.