Management of blood pressure in acute stroke: guidelines and practical tips

Hypertension is the most important modifiable risk factor in stroke. It is well established that lowering the blood pressure definitely reduces the risk of stroke as each 10mmHg lowering of systolic blood pressure reduces the risk of stroke in approximately one third in the person between 60-79 years of age group, however lowering diastolic blood pressure was upon thought to be the main target to reduce stroke and related cardiovascular events but now systolic blood pressure has become the target. A U Shaped well established association exists between level of blood pressure at the time of admission and the stroke outcome is established with poor post stroke outcome at very high and very low blood pressure at onset of stroke. The judicious role of Anti-Hypertensive agents in stroke unit is at times the determining factor for the ultimate stroke outcome in any situation as systolic blood pressure of more than 180mmHg or a mean arterial blood pressure of more than 130mmHg should get immediate attention. Short and rapidly acting intravenous Anti-Hypertensive agents like Labetalol, Hydralazine, Esmolol, Enalapril, & Nitroprusside are the preferred agents in Acute Stroke setting. In the end is the target of BP lowering which is more important than the agent used.