ischemic stroke... stop lowering pressure

Severely elevated blood pressure (BP) and aggressive BP reduction are both associated with poor outcome in acute ischemic stroke (AIS).

Because many stroke patients have long-standing hypertension, blood pressure lowering may result in cerebral hypoperfusion and worsening ischemia.

 It is generally accepted that elevated blood pressures should not be lowered, unless:

• the patient has received thrombolytic treatment
• has a hypertensive emergency (aortic dissection, hypertensive encephalopathy, acute renal failure, acute pulmonary edema, or acute myocardial infarction); 
•  contraindication to elevated blood pressure, such as recent surgery.

The American Stroke Association guidelines recommend that antihypertensive agents should be withheld unless the systolic blood pressure is greater than 220 mm Hg or the diastolic blood pressure is greater than 120 mm Hg . If patients have received thrombolytic therapy, the guidelines advocate maintaining systolic blood pressure less than or equal to 180 mm Hg and diastolic blood pressure less than or equal to 105 mm Hg .

If blood pressure lowering is indicated, it should be instituted cautiously to avoid hypotension.