- Patients with AIS should only receive blood pressure-lowering treatment if there is an indication for emergency treatment, such as: SBP > 185 mmHg or DBP > 110 mmHg when the patient is otherwise eligible for treatment with alteplase; hypertensive encephalopathy; hypertensive nephropathy; hypertensive cardiac failure or myocardial infarction; aortic dissection; pre-eclampsia or eclampsia.
- People with stroke or TIA should have their blood pressure checked, and treatment should be initiated and/or increased as tolerated to consistently achieve a clinic SBP below 130 mmHg, except for people with severe bilateral carotid artery stenosis, for whom a SBP of 140-150 mmHg is appropriate.
- For people with stroke or TIA aged 55 or over, or of African or Caribbean origin at any age, antihypertensive treatment should be initiated with a long-acting dihydropyridine CCB or a thiazide-like diuretic. If target BP is not achieved, an ACE inhibitor or AT2 blocker should be added.
- For people with stroke or TIA not of African or Caribbean origin and younger than 55 years, antihypertensive treatment should be initiated with an ACEI or an AT2 blocker.
- BP-lowering treatment for people with stroke or TIA should be initiated prior to the transfer of care out of hospital or at 2 weeks, whichever is the soonest, or at the first
clinic visit for people not admitted.
- BP-lowering treatment for people with stroke or TIA should be monitored frequently and increased to achieve target blood pressure as quickly as tolerated and safe in
primary care. People whose blood pressure remains above target despite treatment should be checked for medication adherence before being referred for a specialist opinion.