| Reworded | For patients with a blood pressure <220/120 mm Hg, who have not received intravenous thrombolysis or IA MT and do not have any complications requiring urgent blood pressure reduction, initiating or restarting antihypertensive therapy within the first 48–72 hours after AIS showed no efficacy in preventing death or severe disability. | III | A |
| Reworded | For patients who have not received intravenous thrombolysis or IA MT, and have a blood pressure of ≥220/120 mm Hg without other complications requiring urgent blood pressure reduction, the efficacy of initiating or restarting antihypertensive therapy within the first 48–72 hours after AIS is uncertain. Lowering blood pressure by 15% within the first 24 hours after the onset of a stroke may be considered reasonable. | IIb | C |
| Reworded | For patients with AIS with concomitant comorbidities such as acute coronary events, acute heart failure, aortic dissection, haemorrhagic transformation after thrombolysis or pre-eclampsia/eclampsia, early antihypertensive therapy is indicated. An initial blood pressure reduction of 15% may be considered safe. | I | C |
| Reworded | Correction of hypotension and hypovolaemia is necessary after stroke to maintain adequate systemic perfusion and support the proper functioning of organs. | I | C |
| Reworded | For patients with AIS, the efficacy of pharmacologically induced hypertension is uncertain. | IIb | C |
| New recommendation | For blood pressure targets in patients who had a stroke, it is recommended lowering SBP below 130 mm Hg and DBP below 80 mm Hg, if tolerated by the patient. | I | B |
| The SPS3 trial found that targeting an SBP of <130 mm Hg did not result in a significant reduction in stroke recurrence for patients with recent lacunar stroke, but the rate of ICH was reduced significantly (0.37, 95% CI 0.15 to 0.95, p=0.03).238 A recent meta-analysis showed a significant reduction in stroke with an intensive versus standard target (RR 0.78, 95% CI 0.64 to 0.96).239
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| New recommendation | In patients with IS or TIA attributed to severe intracranial large artery stenosis (70-99%), it is recommended lowering SBP to below 140 mm Hg and DBP to below 90 mm Hg, if tolerated by the patient. | IIa | B |
| The SAMMPRIS trial found that it is safe to control SBP within 140 mm Hg or lower in patients with IS or TIA attributed to severe intracranial large artery stenosis (70-99%), and this is associated with a lower risk of stroke recurrence.240
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| New recommendation | There are insufficient data to provide specific guidance on the selection of antihypertensive medications following AIS. The choice of appropriate antihypertensive drugs should be based on individual patient considerations and the physician’s choice. | IIa | C |
| A comprehensive meta-analysis that included three trials (PROGRESS, PRoFESS and PATS) aimed to evaluate the efficacy of ACE inhibitors (ACEI), angiotensin receptor blockers and diuretics in preventing stroke recurrence among Chinese patients with IS. The findings indicated that the type of medication did not influence the risk of stroke recurrence.241 Several clinical trials indicated that compared with ACEI, calcium channel blockers and placebo, beta-blockers may not significantly reduce the risk of stroke.242–244
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