Should antihypertensive therapies be given to patients with acute ischaemic stroke?

Hypertension is a major risk factor for stroke and many patients with acute stroke have elevated blood pressures. The management of hypertension in the setting of acute ischaemic stroke remains a source of confusion and controversy. Lowering blood pressure in this setting may be hazardous because of impaired cerebral autoregulation. Treatment may be considered in patients who are otherwise candidates for thrombolytic therapy, patients who have severe hypertension or patients who have specific concomitant medical conditions including acute myocardial infarction, aortic dissection, hypertensive encephalopathy, or severe left ventricular failure. In choosing an agent for acute treatment, drugs that can produce a precipitous decline in blood pressure (e.g. sublingual calcium antagonists) should be avoided. Drugs with the capacity to dilate cerebral vessels should be used with caution as they have the potential to increase intracranial pressure. Long term management of hypertension in poststroke patients is often required. The potential for certain classes of drugs (e.g. α₂-adrenergic receptor agonists and α₁-adrenergic receptor antagonists) to impair the recovery process should be considered when choosing an antihypertensive for treatment of these patients.