Stroke is one of the important comorbidities of hypertension, and more than 60% of stroke patients have a history of hypertension. Studies have found that the annual recurrence rate of stroke is as high as 3-5% and is strongly and positively correlated with arterial blood pressure levels. On the other hand, aggressive antihypertensive therapy can significantly reduce the risk of stroke recurrence. Evidence-based evidence suggests that the risk of stroke in patients with stroke is likely to be reduced to the same level as in patients without a history of stroke when blood pressure is controlled to a satisfactory level with antihypertensive therapy. For this reason, the new guidelines also set a higher standard for antihypertensive therapy in this population, advocating that patients with a history of cerebrovascular disease should have their blood pressure reduced to 140/90
mmHg or lower. However, because of the specific pathophysiological mechanisms and clinical features, the acute phase of stroke should be treated more carefully. In acute stroke, especially within one week of onset, plasma cortisol and catecholamine levels are significantly elevated, and patients experience increased intracranial pressure, cerebral hypoxia, pain, and mental stress, which cause a reflex increase in blood pressure. At this time, the body itself will make physiological responses and adjustments to this series of changes. If the blood pressure is lowered too much at this stage, it may aggravate the brain tissue ischemia and hypoxia, which is not conducive to the recovery of the disease or even cause more serious consequences. Therefore, unless the blood pressure is severely elevated (more than 180/105 mmHg), antihypertensive drugs should be temporarily discontinued. It is generally believed that it is most appropriate to maintain blood pressure between 160-180/90-105 mmHg within one week after the onset of acute cerebral infarction. If the blood pressure is severely elevated, some weaker antihypertensive drugs should be used to lower the blood pressure smoothly and slowly. The treatment of hemorrhagic stroke is more complicated than that of ischemic stroke: too high blood pressure may lead to rebleeding or active bleeding, while too low blood pressure may aggravate cerebral ischemia. In these patients, it is now considered more prudent to maintain blood pressure at or slightly above the prehemorrhagic level. When the blood pressure is too high, some more moderate antihypertensive drugs can be used carefully under the premise of reducing intracranial pressure, so that the blood pressure can be reduced smoothly and slowly. Generally, blood pressure should be reduced by no more than 25% within 2 hours. Too fast or too much blood pressure reduction may have adverse effects on the condition. It is appropriate to maintain blood pressure at 150-160/90-100 mmHg in acute cerebral hemorrhage. Regardless of cerebral hemorrhage or cerebral infarction, once the condition is stabilized, blood pressure lowering treatment should be resumed gradually and blood pressure should be controlled below 140/90mmHg.