Table 19. BP thresholds and targets for patients with stroke.

Stage	Hyperacute	Acute			Convalescence		Chronic
Timing	Ambulance-based	< 1 h		1-24 h	24-72 h (or before discharge)		> 72 h (or after discharge)
Decision	Threshold/target	Threshold	BP target	BP target	Threshold	BP target	BP target (HBPM)
IS w/o IVT or EVT	NR	BP ≥ 220/120 mmHg or others*	SBP ↓15%	Individualized	Stable stroke#	< 140/90 mmHg	< 130/80 mmHg†
IS with IVT	NR	BP ≥ 185/110 mmHg	Before IVT: < 185/110 mmHg	After IVT: < 180/105 mmHg	Stable stroke#	< 140/90 mmHg	< 130/80 mmHg†
IS with EVT	NR	BP ≥ 185/110 mmHg	Before EVT: < 185/110 mmHg; During EVT: 140-180 mmHg	After EVT: < 180/105 mmHg; < 140/90 mmHg (successful recanalization)	Stable stroke#	< 140/90 mmHg	< 130/80 mmHg†
ICH	NR	SBP ≥ 220 mmHg	SBP ↓15%	Individualized (approximately SBP < 140 mmHg)	Stable stroke#	< 140/90 mmHg	< 130/80 mmHg
		SBP ≥ 160 mmHg	SBP↓ by 20-60 mmHg	< 140 mmHg
SAH	NR	SBP ≥ 160 mmHg	120-160 mmHg before the aneurysm is treated		Stable stroke#	120-160 mmHg before the aneurysm is treated	< 130/80 mmHg (after or intentionally waiving aneurysm treatment)

* Other situations needing immediate BP lowering include acute aortic dissection, congestive heart failure with lung edema, hypertensive encephalopathy. ^# Stable stroke means no observed deterioration of neurological deficits owing to brain hypoperfusion. ^† Careful observation of brain hypoperfusion-related side effects caused by BP-lowering therapy may be considered in patients with bilateral internal carotid artery significant stenoses or basilar artery stenosis (> 70% luminal diameter stenosis).

BP, blood pressure; EVT, endovascular thrombectomy; HBPM, home blood pressure measurement; ICH, intracranial hemorrhage; IS, ischemic stroke; IVT, intravenous thrombolysis; NR, not recommended; SAH, subarachnoid hemorrhage; SBP, systolic blood pressure; w/o, without.