Table 7.

BIHS position: Consideration for blood pressure (BP) lowering therapy in acute ischaemic stroke (AIS).

Hypertensive emergency state	Acute ischaemic stroke
Speed of BP reduction and BP targets	1. Balance a reduction in cerebral blood flow and increase in cerebral oedema versus haemorrhagic transformation of ischaemia. Routine anti-hypertensive treatment is not usually required
	2. If BP is greater than >220/120 mmHg, reduce by 10–15% MAP within 24 h.
	3. If BP ≤ 220/120 consider reducing to 185/110 mmHg if thrombolysis/thrombectomy indicated.
	4. All patients should have plans drawn for long term hypertension management (<140/90 mmHg prior to discharge or within few days is a reasonable aim).
Medications	If acute therapy indicated IV labetalol ±IV nicardipine or IV Glyceryl trinitrate (GTN). Choice of agent for long-term management as per NG 136.