In acute ischemic stroke without hemorrhage, what is the recommended BP management?

In acute ischemic stroke without hemorrhage, what is the recommended BP management?

• A. Permissive hypertension up to SBP >185 and DBP >110; avoid aggressive lowering
• B. Aggressive reduction to below 140/90 immediately
• C. Immediate BP normalization regardless of symptoms
• D. No BP management is necessary

Answer: (A)

In acute ischemic stroke without hemorrhage, the brain tissue at risk depends on adequate blood flow from the remaining vessels. Lowering blood pressure too aggressively can reduce perfusion to this ischemic penumbra and worsen the stroke, so the preferred approach is permissive hypertension rather than rapid, aggressive BP lowering. You generally avoid forcing the BP down unless there’s a clear reason (for example, to permit thrombolysis, where BP must be below 185/110 before treatment and kept under about 180/105 after). This is why allowing higher BP up to around the thrombolysis threshold and managing it cautiously is the best strategy. The other options imply aggressive lowering, immediate normalization, or no BP management, which can be harmful or inappropriate in this setting.

In acute ischemic stroke without hemorrhage, the brain tissue at risk depends on adequate blood flow from the remaining vessels. Lowering blood pressure too aggressively can reduce perfusion to this ischemic penumbra and worsen the stroke, so the preferred approach is permissive hypertension rather than rapid, aggressive BP lowering. You generally avoid forcing the BP down unless there’s a clear reason (for example, to permit thrombolysis, where BP must be below 185/110 before treatment and kept under about 180/105 after). This is why allowing higher BP up to around the thrombolysis threshold and managing it cautiously is the best strategy. The other options imply aggressive lowering, immediate normalization, or no BP management, which can be harmful or inappropriate in this setting.