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International Journal of Hypertension
Volume 2013, Article ID 349782, 5 pages
Review Article

Unsolved Issues in the Management of High Blood Pressure in Acute Ischemic Stroke

Department of Neurology and Neurological Intensive Medicine, Klinikum Harlaching, Städtisches Klinikum München GmbH, Thalkirchner Straße 48, 80337 Munich, Germany

Received 22 March 2013; Accepted 3 April 2013

Academic Editor: Blas Gil Extremera

Copyright © 2013 Gordian J. Hubert et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


High blood pressure is common in acute stroke patients. Very high as well as very low blood pressure is associated with poor outcome. Spontaneous fall of blood pressure within the first few days after stroke was associated both with neurological improvement and impairment. Several randomized trials investigated the pharmacological reduction of blood pressure versus control. Most trials showed no significant difference in their primary outcome apart from the INWEST trial which found an increase of poor outcome when giving intravenous nimodipine. Nevertheless, useful information can be extracted from the published data to help guide the clinician's decision. Blood pressure should only be lowered when it is clearly elevated, and early after onset, reduction should be moderate but may be achieved rapidly. No clear recommendations can be given on the substances to use; however, care should be taken with intravenous calcium channel blockers and angiotensin receptor antagonists. Two ongoing randomized trials will help to solve the questions on blood pressure management in acute stroke.