20
General Supportive Early Management
4.3. Blood Pressure Management
COR LOE
Recommendations
General Recommendations (Including Without Reperfusion erapy)
1 C-LD
1. In patients with AIS, hypotension and hypovolemia should
be corrected to maintain systemic perfusion levels necessary
to support organ function.
1 C-EO
2. In patients with AIS, early treatment of hypertension is
indicated when required by comorbid conditions (eg,
concomitant acute coronary event, acute heart failure,
aortic dissection, postthrombolysis sICH, or preeclampsia/
eclampsia) to reduce the risk of complications.
2b C-EO
3. In patients with BP ≥220/120 mm Hg who did not receive
IVT or EVT and have no comorbid conditions requiring
urgent antihypertensive treatment, the benefit of initiating or
reinitiating treatment of hypertension within the first 48 to
72 hours is uncertain.
3: No
benefit
A
4. In patients with BP <220/120 mm Hg who did not receive
IVT or EVT 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 AIS is not effective to prevent death or dependency.
Before Reperfusion Treatment
1 B-NR
5. Patients with AIS who have elevated BP and are otherwise
eligible for treatment with IVT should have their SBP
lowered to <185 mm Hg and diastolic blood pressure (DBP)
<110 mm Hg before IVT therapy is initiated to reduce
hemorrhagic complications.
2a B-NR
6. In patients for whom EVT is planned and who have
not received IVT therapy, it is reasonable to maintain
BP ≤185/110 mm Hg before the procedure to avoid
complications and improve patient outcomes.
Aer IVT
1 B-R
7. BP should be maintained at <180/105 mm Hg for at least the
first 24 hours after IVT treatment.
3: No
benefit
B-R
8. (New and of High Impact) In patients with mild to moderate
severity AIS who have been treated with IVT, intensive SBP
reduction (target of <140 mm Hg compared with <180 mm
Hg ) is not recommended because it is not associated with an
improvement in functional outcome.
