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Blood Pressure Management
5.3.9.2. Acute Ischemic Stroke
COR LOE
Recommendations
1 C-LD
1. In patients with acute ischemic stroke, hypotension and
hypovolemia should be corrected to maintain systemic
perfusion levels necessary to support organ function.
1 B-NR
2. Patients who have elevated BP and are otherwise eligible for
treatment with IV thrombolytics should have their BP lowered
to SBP <185 mm Hg and DBP <110 mm Hg before IV
thrombolytic therapy is initiated and should be maintained
below 180/105 mm Hg for at least the first 24 hours after
initiating thrombolytic therapy to avoid complications.
2a B-NR
3. In patients who undergo endovascular treatment, it is
reasonable to maintain the BP at ≤180/105 mm Hg during
and for 24 hours after the procedure to improve long-term
functional outcomes and prevent death.
2b C-LD
4. In patients with BP of ≥220/120 mm Hg who did not
receive IV thrombolytic or endovascular treatment and have
no comorbid conditions requiring acute antihypertensive
treatment, it might be reasonable to lower BP by 15% during
the first 24 hours after onset of stroke to improve outcomes.
3: No
Benefit
A
5. In patients with BP <220/120 mm Hg who do not receive
IV thrombolysis or endovascular treatment and do not have
a comorbid condition requiring urgent antihypertensive
treatment, initiating or reinitiating treatment of hypertension
within the first 48 to 72 hours after an acute ischemic stroke
is not effective to prevent death or disability.
3: Harm A
6. In patients undergoing successful brain reperfusion with
endovascular treatment for a large vessel occlusion, lowering
SBP <140 mm Hg within the first 24 to 72 hours after
reperfusion can worsen long-term functional outcome.
