A 55-year-old man with blood pressure 200/120 mmHg develops acute ischemic stroke. Neuroimaging confirms an anterior circulation ischemic infarct. He is not a candidate for thrombolysis. According to AHA/ASA guidelines on BP management in acute ischemic stroke without thrombolysis, what is the recommended blood pressure target in the first 24 hours?
- A Permit permissive hypertension; treat only if BP >220/120 mmHg ✓
- B Reduce BP to <140/90 mmHg within 6 hours to prevent haemorrhagic transformation
- C Reduce BP by 25% within the first hour
- D Maintain BP <180/105 mmHg strictly from symptom onset
Correct answer: A. Permit permissive hypertension; treat only if BP >220/120 mmHg
Explanation
In acute ischemic stroke NOT receiving thrombolysis, AHA/ASA guidelines recommend permissive hypertension: antihypertensives should be withheld unless BP exceeds 220/120 mmHg, as elevated BP may represent a physiological compensatory response to maintain perfusion in ischaemic penumbra. Aggressive BP lowering risks worsening cerebral ischaemia. For patients receiving thrombolysis, the threshold for treatment is BP >185/110 mmHg.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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