Stroke: Early treatment of hypertension in the acute phase
DISEASE	INTERVENTION	COMPARISON	RESULTS
Lancet Neurol. 2025 Jul;24(7):571-579. doi: 10.1016/S1474-4422(25)00160-7		Meta-Analysis
IN stroke, haemorrhagic, intracerebral hemorrhage, hypertension in the early acute phase	The Use of intensive (target systolic BP <140 mm Hg within 1 h) blood pressure-lowering treatment using locally available drugs, in the first 3h after symptoms onset As Treatment, Acute	Is better Than guideline-recommended (target systolic BP <180 mm Hg within 1 h) blood pressure treatment	To reduce chances of poor final physical function (modified Rankin 3-6) (OR 0.85), reduce mortality (OR 0.83) and serious adverse events (0.84). There was no effect, however, in haematoma growth on CT
Ann Neurol. 2020 Mar 18. doi: 10.1002/ana.25716. [Epub ahead of print]		Controlled Trial (non-randomized)
IN stroke, hypertension in the early acute phase	The Use of a systolic blood pressure (SBP) goal of < 140 mmHg in the first 24 hours after successful revascularization As Treatment, Acute	Is better Than an SBP goal of < 180 mmHg in the first 24 hours	To improve at 3 months good functional outcome (Rankin 0-2: 52% lower SBP goal VS 44% higher SBP) and mortality (16% lower SBP goal VS 21% higher SBP)
Stroke. 2003 Jul;34(7):1699-703		Randomized Controlled Trial
IN stroke, hypertension in the early acute phase	The Use of modest blood pressure reduction by angiotensin II receptor blockers, candesartan As Treatment, Acute	Is better Than no treatment of hypertension	To reduce cumulative 12-month mortality and reduce vascular events. No cardio-cerebrovascular event occurred as a result of hypotension
Lancet. 2011 Feb 26;377(9767):741-50		Randomized Controlled Trial, Multicenter Study
IN stroke, hypertension in the early acute phase	The Use of modest blood pressure reduction by angiotensin II receptor blockers, candesartan As Treatment, Acute	Is worse Than placebo	To modify death or cardiovascular events at 6 months or to modify functional outcome: higher risk of poor functional outcome with candesartan: OR 1.17.
Health Technol Assess. 2009 Jan;13(9):iii, ix-xi, 1-73		Randomized Controlled Trial
IN stroke, hypertension in the early acute phase	The Use of oral and sublingual lisinopril, oral and intravenous labetalol As Treatment, Acute	Is better Than placebo	To reduce mortality at 3 months, but not mortality or dependence at 2 weeks
Cochrane Database Syst Rev. 2014 Oct 28;2014(10):CD000039. doi: 10.1002/14651858.CD000039.pub3		Systematic Review, Cochrane Review
IN stroke, hypertension in the early acute phase	The Use of various antihypertensive treatments (CCBs, ACEI, ARA, beta blockers and NO donors) As Treatment, Acute	Is equal Than placebo	To modify mortality or functional outcome
BMJ. 2023 Oct 9;383:e076448. doi: 10.1136/bmj-2023-076448		Randomized Controlled Trial, Multicenter Study
IN stroke, hypertension in the early acute phase, not revascularized	The Use of antihypertensive Tt. immediately, aimed at reducing systolic blood pressure by 10%-20% in 24h and a blood pressure <140/90 mm Hg in 7 days As Treatment, Acute	Is equal Than discontinue antihypertensive medications for 7 days if they were taking them, and then receive Tt. on day 8	To modify the odds of dependency or death at 90 days. However, worsened functional outcomes for patients without previous hypertension in subgroup analysis (OR 1.35) (see Notes)