UMEM Educational Pearls

Title: Blood Pressure in Acute Ischemic Stroke

Category: Critical Care

Posted: 10/13/2020 by Mike Winters, MBA, MD (Updated: 12/26/2024)
Click here to contact Mike Winters, MBA, MD

Blood Pressure Management in Acute Ischemic Stroke

Blood pressure (BP) is elevated in many patients who present to the ED with an acute ischemic stroke (AIS).
Severe elevations in BP are associated with hemorrhagic transformation, as well as cardiac and renal complications.
As such, it is important to know the various BP goals for patients with an AIS.
- Permissive hypertension with a BP less than or equal 220/120 mm Hg is recommended for patients not receiving IV-tPA or endovascular therapy.
- BP should be lowered to less than or equal to 180/105 mm Hg for patients who have received IV-tPA.
- BP goals for patients who have received endovascular therapy remain controversial and should be individualized based on the degree of recanalization.

Herpich F, et al. Management of acute ischemic stroke. Crit Care Med. 2020; 48(11):1654-1663.