Background: Stroke represent one of the most devastating of all neurological diseases, affecting about
15 million people per year and is an important cause of morbidity and mortality worldwide and currently the
leading cause of adult disability in developed countries. Blood pressure and heart rate may undergo several modifications
in patients with both ischemic and hemorrhagic stroke in fact raised blood pressure levels may lead to
cerebral edema, hematoma expansion or hemorrhagic transformation and in contrast low blood pressure can lead
to increased cerebral infarction or perihematomal ischemia. In addition, ECG abnormalities and cardiac arrhythmias,
especially atrial fibrillation, are relatively frequent after stroke, and other well known complications such as
heart failure, miocardial infarction and sudden death have been reported. The acute phase of brain infarction
requires a careful management of both blood pressure levels and heart rate but despite the large amount of information,
blood pressure and heart rate management are still under debate.
Objective: Provide clear indications about the optimal blood pressure and heart rate management of both ischemic
and hemorrhagic stroke, in view of the main available evidence.
Method: In this review, we discuss the evidence for blood pressure and heart rate management in acute stroke, the
challenges and issues raised, and look to on-going and future trials that may provide some clarity in this controversial