My coauthors and I thank Dr Slosberg for his important comments. Lowering BP in the setting of ischemic stroke may pose harm to the penumbra. Elevated BP on reperfusion could also be harmful by predisposing to hemorrhagic conversion and promoting edema. When patients are being considered for revascularization in the setting of acute ischemic stroke but have BPs exceeding recommended guidelines, our choices include lowering the BP to treat with tissue plasminogen activator (tPA) or not lowering BP and withholding tPA. Guidelines on tPA protocol call for BP lowering to less than 185/110 mm Hg prior to treatment,1 but little data regarding the safety and outcomes in such cases exist.
Martin-Schild S. Aggressive Blood Pressure Lowering in Acute Ischemic Stroke—Reply. Arch Neurol. 2009;66(6):804-805. doi:10.1001/archneurol.2009.121