Blood Pressure Reduction and Acute Ischemic Stroke

As much as I read the literature, I really don’t know the BP is my friend or enemy. If you look at the Stroke guideline published in 2013, their recommendation for lowering  BP is”not to lower the blood pressure during the initial 24 hours of acute ischemic stroke unless the blood pressure is >220/120 mm Hg” but there is no reference to this quote, only recommends the the previous recommendation! JAMA published an online article a Randomized Clinical Trial last month:
The Objective was : to evaluate whether immediate blood pressure reduction in patients with acute ischemic stroke would 1) reduce death and 2) major disability at 14 days or hospital discharge.
This is from China Antihypertensive Trial in Acute Ischemic Stroke. 4071 patients  within 48 hours of onset and elevated systolic blood pressure enrolled.”Patients (n = 2038) were randomly assigned to receive antihypertensive treatment (aimed at lowering systolic blood pressure by 10% to 25% within the first 24 hours after randomization, achieving blood pressure less than 140/90 mm Hg within 7 days, and maintaining this level during hospitalization) or to discontinue all antihypertensive medications (control) during hospitalization (n = 2033)”.

Primary outcome
was a combination of death and major disability at 14 days or hospital discharge.
 and their conclusion is: Among patients with acute ischemic stroke, blood pressure reduction with antihypertensive medications, compared with the absence of hypertensive medication, did not reduce the likelihood of death and major disability at 14 days or hospital discharge.

There is no doubt that for every  patient you should decide individually but in general the concept of lowering aggressively BP  should stay in 2013 and we should not carry that to 2014!

JAMA, Nov. 17, 2013: Effects of Immediate Blood Pressure Reduction on Death and Major Disability in Patients With Acute Ischemic Stroke

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