ESOC 2025 | Guidance on monitoring blood pressure after acute ischemic or hemorrhagic stroke
Hanne Christensen, MD, PhD, of Bispebjerg Hospital, Copenhagen, Denmark, offers guidance on monitoring blood pressure after an acute ischemic or hemorrhagic stroke. Prof. Christensen recommends reducing blood pressure to below 180/110 mmHg after intravenous thrombolysis (IVT), and to a systolic blood pressure not exceeding 140 mmHg in patients with hemorrhagic stroke. For patients without IVT or hemorrhage, she suggests doing nothing, as the risks of blood pressure reduction may outweigh the benefits. This interview took place at the 11th European Stroke Organisation Conference (ESOC) in Helsinki, Finland.
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Transcript
This is an area which has been discussed intensely at least for the last something like 30 years. The question is that we have, there’s a lot of observational studies finding that high blood pressure in the acute phase is related to poorer outcome but also that very low blood pressure is related to it. So this has been followed in ischemic stroke with a number of trials aiming to reduce the blood pressure with the overall aim of improving outcome...
This is an area which has been discussed intensely at least for the last something like 30 years. The question is that we have, there’s a lot of observational studies finding that high blood pressure in the acute phase is related to poorer outcome but also that very low blood pressure is related to it. So this has been followed in ischemic stroke with a number of trials aiming to reduce the blood pressure with the overall aim of improving outcome. But most of those trials have been neutral. A few of them, including the SCAST trial, were actually slightly negative because the blood pressure dips were too large, leading to harm, basically. So as to patients who are receiving IVT, there has to be a cap on the blood pressure and it has to be reduced to a specific level. And if we’re looking at patients with hemorrhage, then the blood pressure needs to be reduced to a systolic blood pressure not exceeding 140. So the short answer is after IVT, intravenous thrombolysis, blood pressure should be reduced to below 180 over 110. In hemorrhagic stroke, the systolic blood pressure should go no higher than 140 mmHg. All others, do nothing, keep your hands in your pocket.
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