Systemic blood pressure and stroke outcome and recurrence.

Although it is clear that hypertension is a primary cause of stroke, there has been controversy concerning blood pressure management after stroke. Recent studies indicate that lowering systemic blood pressure after stroke reduces the risk for recurrent stroke or vascular events, but other studies provide evidence that blood pressure should not be lowered in the first week after stroke onset. Additional investigations have provided preliminary evidence that raising blood pressure in the first few days after stroke may improve outcome in selected patients. However, other studies have recorded the benefit of lowering blood pressure in some patients at the acute stage, whereas still others have identified patients in whom lowering blood pressure even later after stroke may be more harmful than beneficial. The remaining challenge is to identify efficient measures for determining when to lower blood pressure in each case of ischemic stroke.