Hypertension in Stroke

European Stroke Organisation guidelines

BP lowering in acute stroke:

Acute Ischaemic Stroke:

SBP <220mmHg

Don't intervene with BP meds. Check for pain, full bladder etc. Treat other symptoms of stroke (eg, headache, agitation, nausea, vomiting). Treat other acute complications of stroke, including hypoxia, increased intracranial pressure, seizures, or hypoglycemia

SBP >220mm Hg

Safe and reasonable to intervene but no evidence of improvement in patient outcomes. Options include:

Acute Haemorrhagic Stroke:

Continued uncertainty, with no hard evidence of any improvement in patient outcome.

There is some minor evidence of improved surrogate endpoints of uncertain clinical significance (haematoma growth) and an expert consensus recommendation to lower BP in acute bleeds that, to my mind, seems as yet mostly divorced from hard evidence. Medication options as above.

Content by Dr Íomhar  O' Sullivan. ESO Guidelines - thank you to DrLiam Healy, CUH. Last review Dr ÍOS 23/08/23