Blood pressure: what happens during an acute stroke?

Abstract

At the acute stage of ischemic or hemorrhagic stroke, elevation of blood pressure (BP) occurs in at least 80% of the patients. Observational studies have shown that patients with elevated BP have a worse prognosis. While the benefit of BP reduction is clearly established for primary and secondary stroke prevention, BP management at the acute stage remains controversial. Current guidelines differ according to whether the patient presents an ischemic or hemorrhagic stroke. Available pathophysiological data argue either in favor or against intensive BP reduction. However, evidence from randomized clinical trials remains scarce and disappointing. We reviewed the pathophysiology of brain circulation and published evidences in order to examine the limitations of current guidelines for BP management after acute ischemic and hemorrhagic strokes.