Key Points
- To summarize current evidence regarding optimal blood pressure management targets for primary and secondary stroke prevention, as well as during acute stroke presentation.
- Synthesized findings from major epidemiological investigations and randomized clinical trials evaluating intensive versus standard blood pressure lowering.
- Evaluated target thresholds and outcomes separately across primary prevention, secondary prevention in lacunar infarction, acute intracerebral hemorrhage, and acute ischemic stroke.
- Evidence from clinical trials supports intensive blood pressure lowering for primary stroke prevention and vascular protection, though secondary prevention evidence remains largely confined to lacunar infarction cohorts.
- Immediate blood pressure lowering targeting systolic blood pressure below 140 mm Hg is recommended in acute intracerebral hemorrhage.
- Early blood pressure lowering in acute ischemic stroke shows no benefit for functional recovery or future vascular events and carries potential risk of neurological deterioration.
Structured PICO
Does blood pressure lowering therapy prevent stroke and improve outcomes in patients at risk for or experiencing acute stroke?
PPopulationPatients at risk for stroke (primary and secondary prevention) and patients with acute stroke (intracerebral hemorrhage and acute ischemic stroke)
IInterventionBlood pressure lowering therapy (including intensive BP lowering and immediate BP lowering targeting systolic BP <140 mm Hg)
OOutcomeStroke prevention, functional outcome, and future vascular eventshard clinical
This review highlights that while intensive BP lowering benefits primary stroke prevention and acute intracerebral hemorrhage, early BP lowering in acute ischemic stroke is generally not recommended.