Blood pressure management in stroke

We appreciated reading the article by Bowry et al.1 addressing the long-debated and controversial issue of management of blood pressure (BP) in stroke. The authors integrated different relevant aspects such as stroke subtype, eligibility for reperfusion therapy, cerebrovascular anatomy, and concurrent medical conditions to provide practical suggestions aimed at formulating a timely, effective strategy for BP control in both ischemic and hemorrhagic stroke.

Besides BP reduction at specific target goals, further efforts should also be undertaken to ensure stability of BP levels. BP variability has been increasingly recognized as a strong vascular risk factor and a predictor of stroke outcome independent of mean BP levels.2–4 In our opinion, greater attention should be paid to this new perspective because of the potential implications in clinical practice. First, continuous monitoring should be tailored to provide additional information on short- and long-term BP fluctuations. Second, physicians should not be falsely reassured by BP readings within “normal” ranges if high variability coexists. Finally, practitioners should be aware that BP stability may be affected by both the intensity of treatment and the type of antihypertensive agent.5

Disclosures:

The authors report no disclosures.