Stroke in hypertensive emergencies

Elevated BP is common after acute ischaemic stroke, but in most cases it resolves without specific treatment. Aggressive BP reduction should be avoided in the acute phase of stroke as it may reduce cerebral perfusion and worsen ischaemia. For further information on management of ischaemic stroke, see General measures for acute ischaemic stroke.

In haemorrhagic stroke, especially in patients taking antiplatelet or anticoagulant therapy, urgent BP reduction may be necessary to reduce the extent of haemorrhage. It is safe to lower systolic BP to about 140 mmHg. Seek specialist haematological advice about possible reversal of anticoagulation. See Intracerebral haemorrhage for more information.