Blood pressure management in patients with acute stroke

The majority of patients with acute stroke present with elevated blood pressure values. Physicians face the therapeutic dilemma of treating or not treating hypertension in acute stroke, and also the challenge of selecting the most appropriate antihypertensive drug. Current supportive evidence is conflicting, prolonging this longstanding debate. This review presents the most recent literature on this highly specific, but very common, therapeutic problem. The different methodological approaches and the conflicting results underline the urgent need for new prospective randomized trials of sufficient power to evaluate the different strategies of blood pressure management in defined stroke subtype groups. This might be the only way to find reliable answers and to define guidelines for an effective blood pressure regulation in the setting of acute stroke.