title: Timing of blood pressure lowering in acute ischemic stroke.
abstract: Whether there are any benefits without harm from early lowering of blood pressure (BP) in the setting of acute ischemic stroke (AIS) has been a longstanding controversy in medicine. Whilst most studies have consistently shown associations between elevated BP, particularly systolic BP, and poor outcome, some also report that very low BP (systolic <130 mmHg) and large reductions in systolic BP are associated with poor outcomes in AIS. However, despite these associations, the observed U- or J-shaped relationship between BP and outcome in these patients may not be causally related. Patients with more severe strokes may have a more prominent autonomic response and later lower BP as their condition worsens, often pre-terminally. Fortunately, substantial progress has been made in recent years with new evidence arising from well-conducted randomized trials. This review outlines new evidence and recommendations for clinical practice over BP management in AIS.
authors.affiliation: The George Institute for Global Health, Sydney, Australia.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Carcel
authors.forename: Craig S
authors.initials: CS
authors.lastname: Anderson
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002545:Brain Ischemia / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology*; D002986:Clinical Trials as Topic; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D020521:Stroke / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*
chemical_list: D000959:Antihypertensive Agents