Blood pressure control after acute stroke

Abstract

Background: Although long-term blood pressure control is known to prevent stroke, acute blood pressure reduction after stroke is associated with worse neurological and functional outcome.

Vasoactive drug treatment after stroke: Chronic blood pressure reduction for secondary prevention of stroke is presently being tested within the PROGRESS trial. This study uses angiotensin-converting enzyme (ACE) inhibitor-based treatment (perindopril) versus placebo. ACE inhibitors may reduce blood pressure without adversely affecting cerebral blood flow. We have recently reported elsewhere that perindopril 4 mg once daily, initiated within 2-7 days of acute ischaemic stroke, reduces blood pressure without adverse effects on cerebral blood flow as measured by Doppler ultrasound. Nevertheless, the optimal policy with regard to blood pressure management in the first 48 h after acute stroke remains uncertain.

Conclusions: A clinical trial is proposed to establish whether it is better to maintain pre-existing antihypertensive therapy or to discontinue this temporarily.