Stroke blood pressure guidelines: Initial Management for Acute Stroke

One should always be wary if they have high blood pressure or it can lead to a lot of dangerous things like heart disease. Statistically speaking, about half the people with untreated high blood pressure die due to heart diseases associated with poor blood flow while the other third die because of stroke. The last one is the leading cause of acute long-term disability and death. If you or your loved ones are diagnosed with high blood pressure, learn these stroke blood pressure guidelines because most people who have suffered from a stroke for the first time also had hypertension.

Stroke Initial Treatment

There are initial stroke blood pressure guidelines to evaluate as well as assess to stabilize patients with stroke that is done within the span of 60 minutes upon patient’s arrival. Below are recommended stroke evaluation time benchmarks for potential thrombolyisis candidate for early management of patients.

  1. Time interval : door to doctor

Time target         : 10 min

  1. Time interval : Access to neurologic expertise

Time target         : 15 min

  1. Time interval : door to CT scan completion

Time target         : 25 min

  1. Time interval : door to CT interpretation

Time target         : 45 min

  1. Time interval : door to treatment

Time target         : 60 min

  1. Time interval : admission to stroke unit or ICU

Time target         : 3 h

Note that, thrombotic as well as embolic ischemic stroke can cause poor flow states. That’s why, aggressive attempts to lower blood pressure has the potential to decrease perfusion pressure as well as prolong ischemia. Furthermore, rapid reduction of blood pressure regardless of the degree of hypertension can be harmful. Studies show that blood pressure usually drops in the first 24 hours right after acute stroke takes place

Stroke blood pressure guidelines

The need to maintain adequate cerebral flow is really needed so severe hypertension should be treated in standard fashion with aggressive fluid resuscitation, a search for the etiology of hypertension and this one is only necessary, vasopressor support. Moreover, baseline systolic blood pressure under 100 mg Hg as well as diastolic blood pressure under 70 mm Hg highly relate to a worse outcome. General convention dictates that it is only necessary to lower blood pressure if systolic pressure is in excess of 220 mm Hg and if diastolic pressure is higher than 120 mm Hg.

Read More : Untreated Sinus Infection and the Possible Further Risks

Below is the blood pressure management guidelines for stroke patients.

  1. Candidate for fibrinolysis

Pretreatment:    SBP > 185 or

 DBP > 110 mm Hg

Post-treatment: DBP > 140 mm Hg

 SBP > 230 mm Hg or

 DBP 121 – 140 mm Hg

SBP 180 – 230 mm Hg or

DBP 105 – 120 mm Hg

  1. Non-candidates for fibrinolysis

DBP > 140 mm Hg

SBP > 220 or

DBP 121 – 140 mm Hg or

MAP > 130 mm Hg

SBP < 220 mm Hg or

DBP 105 – 120 mm Hg or

MAP < 130 mm Hg


MAP: mean arterial pressure

IVP: IV push

SBP: systolic blood pressure

DBP: diastolic blood pressure

The stroke blood pressure guidelines above are adapted from 2005 Advanced Cardiac Life Support (ACLS) guidelines as well as 2007 American Stroke Association Scientific Statement.

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