Blood Pressure Management in Acute Stroke

Palaniappan LP, Allen NB, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, et al. 2026 Heart Disease and Stroke statistics: a report of US and Global Data From the American Heart Association. Circulation. 2026;153(9):e275–906. https://doi.org/10.1161/CIR.0000000000001412.

Article  PubMed  Google Scholar 

Bath PM, Song L, Silva GS, Mistry E, Petersen N, Tsivgoulis G, et al. Blood Pressure Management for Ischemic Stroke in the First 24 Hours. Stroke. 2022;53(4):1074–84. https://doi.org/10.1161/STROKEAHA.121.036143.

Article  PubMed  PubMed Central  Google Scholar 

McManus M, Liebeskind DS. Blood pressure in acute ischemic stroke. J Clin Neurol. 2016;12(2):137–46. https://doi.org/10.3988/jcn.2016.12.2.137.

Article  PubMed  PubMed Central  Google Scholar 

Qureshi AI, Ezzeddine MA, Nasar A, Suri MF, Kirmani JF, Hussein HM, et al. Prevalence of elevated blood pressure in 563,704 adult patients with stroke presenting to the ED in the United States. Am J Emerg Med. 2007;25(1):32–8. https://doi.org/10.1016/j.ajem.2006.07.008.

Article  PubMed  PubMed Central  Google Scholar 

Xie X, Zhong C, Liu X, Pan Y, Wang A, Wei Y, et al. Early versus delayed antihypertensive treatment after acute ischemic stroke by hypertension history. Stroke. 2025;56(3):631–9. https://doi.org/10.1161/STROKEAHA.124.049242.

Article  PubMed  CAS  Google Scholar 

Aries MJ, Elting JW, De Keyser J, Kremer BP, Vroomen PC. Cerebral autoregulation in stroke: a review of transcranial Doppler studies. Stroke. 2010;41(11):2697–704. https://doi.org/10.1161/STROKEAHA.110.594168.

Article  PubMed  Google Scholar 

Reinhard MRS, Hetzel A. Cerebral autoregulation in acute ischemic stroke. Perspect Med. 2012;1:194–7. https://doi.org/10.1016/j.permed.2012.02.028.

Article  Google Scholar 

Gorelick PB, Qureshi S, Farooq MU. Management of blood pressure in stroke. Int J Cardiol Hypertens. 2019;3:100021. https://doi.org/10.1016/j.ijchy.2019.100021.

Article  PubMed  PubMed Central  Google Scholar 

Jordan JD, Powers WJ. Cerebral autoregulation and acute ischemic stroke. Am J Hypertens. 2012;25(9):946–50. https://doi.org/10.1038/ajh.2012.53.

Article  PubMed  Google Scholar 

Oliveira-Filho J, Silva SC, Trabuco CC, Pedreira BB, Sousa EU, Bacellar A. Detrimental effect of blood pressure reduction in the first 24 hours of acute stroke onset. Neurology. 2003;61(8):1047–51. https://doi.org/10.1212/01.WNL.0000092498.75010.

Article  PubMed  CAS  Google Scholar 

Bangalore S, Schwamm L, Smith EE, Hellkamp AS, Suter RE, Xian Y, et al. Blood pressure and in-hospital outcomes in patients presenting with ischaemic stroke. Eur Heart J. 2017;38(37):2827–35. https://doi.org/10.1093/eurheartj/ehx330.

Article  PubMed  PubMed Central  Google Scholar 

Hao Z, Liu M, Wang D, Wu B, Tao W, Chang X. High blood pressure on admission in relation to poor outcome in acute ischemic stroke with intracranial atherosclerotic stenosis or occlusion. J Stroke Cerebrovasc Dis. 2014;23(6):1403–8. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.11.025.

Article  PubMed  Google Scholar 

Leonardibee J, Bath PM, Phillips SJ, Sandercock PA, Group ISTC. Blood pressure and clinical outcomes in the International Stroke Trial. Stroke. 2002;33(5):1315–20. https://doi.org/10.1161/01.str.0000014509.11540.66.

Article  PubMed  Google Scholar 

Kang J, Ko Y, Park JH, Kim WJ, Jang MS, Yang MH, et al. Effect of blood pressure on 3-month functional outcome in the subacute stage of ischemic stroke. Neurology. 2012;79(20):2018–24. https://doi.org/10.1212/WNL.0b013e3182749eb8.

Article  PubMed  PubMed Central  Google Scholar 

Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, et al. 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2022;53(7):e282–361. https://doi.org/10.1161/STR.0000000000000407.

Article  PubMed  CAS  Google Scholar 

Prabhakaran S, Gonzalez NR, Zachrison KS, Adeoye O, Alexandrov AW, Ansari SA, et al. 2026 Guideline for the early management of patients with acute ischemic stroke: a guideline from the American Heart Association/American Stroke Association. Stroke. 2026. Published online January 26, 2026. https://doi.org/10.1161/STR.0000000000000513.

Vemmos KN, Tsivgoulis G, Spengos K, Zakopoulos N, Synetos A, Manios E, et al. U-shaped relationship between mortality and admission blood pressure in patients with acute stroke. J Intern Med. 2004;255(2):257–65. https://doi.org/10.1046/j.1365-2796.2003.01291.x.

Article  PubMed  CAS  Google Scholar 

Visvanathan A, Dennis M, Whiteley W. Parenteral fluid regimens for improving functional outcome in people with acute stroke. Cochrane Database Syst Rev. 2015;2015(9):CD011138. https://doi.org/10.1002/14651858.CD011138.pub2.

Article  PubMed  PubMed Central  Google Scholar 

Strømsnes TA, Kaugerud Hagen TJ, Ouyang M, Wang X, Chen C, Rygg SE, et al. Pressor therapy in acute ischaemic stroke: an updated systematic review. Eur Stroke J. 2022;7(2):99–116. https://doi.org/10.1177/23969873221078136.

Article  PubMed  PubMed Central  Google Scholar 

Rosenfeldt Z, Conklen K, Jones B, Ferrill D, Deshpande M, Siddiqui FM. Comparison of nicardipine with clevidipine in the management of hypertension in acute cerebrovascular diseases. J Stroke Cerebrovasc Dis. 2018;27(8):2067–73. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.03.001.

Article  PubMed  Google Scholar 

Vitt JR, Trillanes M, Hemphill JC 3rd. Management of Blood Pressure During and After Recanalization Therapy for Acute Ischemic Stroke. Front Neurol. 2019;10:138. https://doi.org/10.3389/fneur.2019.00138.

Article  PubMed  PubMed Central  Google Scholar 

Clark WM, Wissman S, Albers GW, Jhamandas JH, Madden KP, Hamilton S. Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. JAMA. 1999;282(21):2019–26. https://doi.org/10.1001/jama.282.21.2019.

Article  PubMed  CAS  Google Scholar 

Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317–29. https://doi.org/10.1056/NEJMoa0804656.

Article  PubMed  CAS  Google Scholar 

Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA. 1995;274(13):1017–25.

Article  PubMed  CAS  Google Scholar 

Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet. 1998;352(9136):1245–51. https://doi.org/10.1016/s0140-6736(98)08020-9.

Article  PubMed  CAS  Google Scholar 

National Institute of Neurological D, Stroke rt PASSG. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581–7. https://doi.org/10.1056/NEJM199512143332401.

Article  Google Scholar 

Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11–20. https://doi.org/10.1056/NEJMoa1411587.

Article  PubMed  CAS  Google Scholar 

Bracard S, Ducrocq X, Mas JL, Soudant M, Oppenheim C, Moulin T, et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol. 2016;15(11):1138–47. https://doi.org/10.1016/S1474-4422(16)30177-6.

Article  PubMed  CAS  Google Scholar 

Brott TG, Haley EC Jr., Levy DE, Barsan W, Broderick J, Sheppard GL, et al. Urgent therapy for stroke. Part I. Pilot study of tissue plasminogen activator administered within 90 minutes. Stroke. 1992;23(5):632–40. https://doi.org/10.1161/01.str.23.5.632.

Article  PubMed  CAS 

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