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Comment & Response
June 11, 2014

Antihypertensive Therapy After Acute Ischemic Stroke

Author Affiliations
  • 1Department of Neurology and Stroke Unit, Sant’Anna Hospital, Como, Italy
JAMA. 2014;311(22):2334. doi:10.1001/jama.2014.5164

To the Editor Dr He and colleagues1 reported no beneficial effects on death and major disability among patients with ischemic stroke who were promptly treated to reduce blood pressure. In previous studies, elevated blood pressure is present in about 80% of patients with ischemic stroke, and in the next few days a spontaneous decline often happens.2 Although elevated blood pressure contributes to a poor outcome, several trials have failed to demonstrate a clinical benefit of moderate to intensive blood pressure reduction during the acute phase.3 The mechanisms of this transitory elevation (eg, the increase in plasma catecholamines due to autonomic nervous system activation, the response to decreased focal cerebral perfusion, or the site of the brain lesion, especially brain stem4) are not well understood.