Treatment of Blood Pressure in Acute Stroke

Many patients who experience a stroke have elevated blood pressure at the time of their stroke. For ischemic stroke (blood clots), the current practice is NOT to lower blood pressure during the first few days, for fear that lowering the blood pressure would worsen the stroke. Current guidelines have not recommended blood pressure lowering within the first 24-48 hours, except in specific situations. Very often blood pressure will decrease within the first 24 hours without any specific treatment. Whether blood pressure lowering medications should be immediately prescribed, or whether previously taken blood pressure medications should be continued shortly following stroke, is a question that has not been sufficiently answered.
A recent report of a large study performed in Scandinavia adds some additional information. The SCAST study, published in The Lancet included over 2000 patients. Half of the patients were prescribed an antihypertensive, candesartan. There was modest lowering of blood pressure in the treatment group. At six months, there were no significant differences in outcome measures, including functional disability.
The results of this study, added to the results of ten previous ones looking at blood pressure lowering following ischemic stroke, indicate that lowering blood pressure with medications immediately following stroke does not have a beneficial effect on functional outcome.
We continue to await the results of a large trial that should help answer the question of whether blood pressure lowering drugs should be continued. Until then, no changes in current practice are suggested by the recent data.

2 thoughts on “Treatment of Blood Pressure in Acute Stroke

  1. Very helpful and up to date information on a topic that is important to know. The article speaks of “moderate” lowering of blood pressure. What about enthusiastic ER doctors who lower blood pressure significantly under these circumstances?

    • Moderate blood pressure reductions averaged 5 mm Hg. Emergency room physicians are currently trained not to automatically reduce blood pressure in ischemic stroke patients, unless they are to undergo therapy with clot dissolving drugs such as tPA, and their pressures are above known acceptable limits.

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