Recommendation	Class	Level	Reference
In patients who are treated with intravenous recombinant tissue plasminogen activator (IV-TPA), in order to reduce the risk of intracerebral hemorrhage (ICH), it is reasonable to lower BP to < 185/100 mmHg before treatment and to maintain BP < 180/105 mmHg during the first 24 hours.	I	B	[152, 153]
For patients undergoing endovascular recanalization therapy (ERT), it is reasonable to maintain preoperative BP < 185/110 mmHg to reduce the risk of cerebral hemorrhage. During the first 24 hours after ERT, the optimal BP level remains uncertain and should be individualized based on the patient’s clinical and imaging profiles. In general, maintaining BP < 180/105 mmHg may be considered. However, a lower BP level may be considered in patients who achieved successful reperfusion.	IIb	C	[154–161]
In patients with persistent high BP levels of > 140/90 mmHg and in a stable neurological condition without contraindications to BP lowering, it is reasonable to initiate antihypertensive therapy before or at discharge in order to improve long-term BP control.	IIa	B	[162, 163]
The benefit of BP lowering within 48 to 72 hours after stroke onset is uncertain in acute ischemic stroke patients with BP ≥220/120 mmHg not receiving IV-TPA or ERT and having no comorbidities. If BP lowering is required based on clinical judgment, BP lowering by approximately 15% may be considered during the first 24 hours.	IIb	C	[7]
In acute ischemic stroke patients with BP < 220/120 mmHg not receiving IV-TPA or ERT and having no comorbidities, initiating BP lowering within 48 to 72 hours after stroke onset is not recommended because it neither improves functional disabilities nor reduces major vascular events at 3 to 6 months.	III	A	[162–164]