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Antihypertensive therapy in acute ischemic stroke: where do we stand?

Journal of Human Hypertension volume 32, pages 799–807 (2018)Cite this article

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Abstract

Despite the proven benefits of strict blood pressure (BP) control on primary and secondary prevention of stroke, management of acute hypertensive response in the early post-stroke period is surrounded by substantial controversy. Observational studies showed that raised BP on ischemic stroke onset is prognostically associated with excess risk for early adverse events and mortality. By contrast, randomized controlled trials and recent meta-analyses showed that although antihypertensive therapy effectively controls elevated BP in the acute stage of ischemic stroke, this BP-lowering effect is not translated into improvement in the risk of death or dependency. On this basis, acute and aggressive BP responses within 24 h of stroke onset should be avoided and antihypertensive therapy is recommended only for patients presenting with acute ischemic stroke and BP > 220/120 mmHg or those with BP > 185/110 mmHg who are eligible for therapy with intravenous tissue plasminogen activator. By contrast, recent clinical trials showed that intensive BP lowering to levels < 140 mmHg for systolic BP is safe and lowers the risk of hematoma expansion in patients with acute intra-cerebral hemorrhage and this BP target is recommended by current international guidelines. Herein, we provide an overview of randomized trials and recent meta-analyses on the management of hypertension during the acute stage of ischemic stroke. We discuss several areas of uncertainty and conclude with perspectives for future research.

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Acknowledgements

This work was not supported by any source and represents an original effort of our part.

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Authors and Affiliations

  1. 2nd Propedeutic Department of Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Eleni Georgianou, Konstantinos Petidis, Vasilios G. Athyros & Asterios Karagiannis

  2. Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Panagiotis I. Georgianos

  3. Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Pantelis A. Sarafidis

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  1. Eleni Georgianou
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Correspondence to Eleni Georgianou.

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Georgianou, E., Georgianos, P.I., Petidis, K. et al. Antihypertensive therapy in acute ischemic stroke: where do we stand?. J Hum Hypertens 32, 799–807 (2018). https://doi.org/10.1038/s41371-018-0105-7

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