In a randomized trial, outcomes were neither better nor worse with early antihypertensive therapy.A 2013 guideline from the American Stroke Association recommends that:
…we avoid antihypertensive drug therapy during the first 24 hours after onset of acute ischemic stroke unless systolic or diastolic blood pressure (BP) exceeds 220 mm Hg or 120 mm Hg, respectively. (The threshold is 185/110 mm Hg for patients receiving thrombolytic therapy; Stroke 2013; 44:870) The concern is that early BP lowering might worsen stroke outcomes. However, no large randomized trials have tested this theory, until now.
Researchers in China randomized 4700 patients with acute ischemic stroke to receive antihypertensive therapy (target BP, 140/90 mm Hg) or no antihypertensive therapy, initiated within 24 hours. Patients were excluded if BP was >220/120 mm Hg, thrombolytic therapy was given, or compelling reasons existed to lower BP (e.g., severe heart failure). Treatment algorithms included angiotensin-converting–enzyme inhibitors, calcium-channel blockers, and diuretics. At entry, mean BP was 166/97 mm Hg.
At 24 hours, mean systolic BP had fallen by 22 mm Hg in the treatment group and by 13 mm Hg in the control group — a significant difference. At 1 week, systolic BP remained separated by about 10 mm Hg, and two thirds of intervention patients (vs. one third of controls) had systolic BP lower than 140 mm Hg. However, the outcome of death or major disability was identical in the two groups at 14 days (34%) and 3 months (25%).
Source: Journal Watch