Stroke is the main disease that endangers the health of middle-aged and elderly people in China. Numerous studies at home and abroad have confirmed that hypertension is the most important risk factor for stroke, and long-term treatment of hypertensive patients and effective blood pressure control can reduce the occurrence and recurrence of stroke. Blood pressure management in secondary prevention of ischemic stroke The US JNC7 hypertension guidelines state that hypertension treatment can prevent stroke recurrence and other vascular events in patients with non-acute ischemic stroke, and that all patients with ischemic stroke/TIA benefit from hypertension treatment, but the specific target blood pressure and the magnitude of the reduction are still unclear and should be individualized A meta-analysis of antihypertensive therapy for the prevention of cardiovascular disease, published in BMJ in 2009, analyzed a total of 104 RCTs from 1966 to 2007 with cardiac events (CHD) and stroke events as endpoints and showed that the endpoint benefit for CHD and stroke varied by blood pressure level; the greater the degree of blood pressure reduction, the The greater the degree of BP reduction, the better the reduction in cardiovascular events, especially in younger people, those with high initial BP, and those on polypharmacy; the endpoint benefit for CHD and stroke varied by type of BP-lowering drug, with CCB, ARB and diuretics being superior in the stroke population. In the PROGRESS study, combination therapy was shown to be better at preventing stroke recurrence than monotherapy with antihypertensive drugs. An article on combination antihypertensive therapy published in nature review showed better clinical benefit of combination therapy with renin-angiotensin inhibitors and long-acting CCBs. A recent national study survey showed that although various antihypertensive drugs are used in cardiovascular units for different indications, CCBs are used in the highest proportion in neurology. Much of the neurological benefit stems from the effect of CCB therapy on carotid IMT, and a 2006 study published in the journal stroke showed that CCB more significantly inhibited or even reversed carotid IMT while lowering blood pressure. As salt intake increases, blood pressure rises in parallel, with salt-sensitive hypertension accounting for 50% to 60% of the total population in China. A study looking at the antihypertensive effect of CCB in the high-salt diet phase and low-salt diet phase showed that the antihypertensive effect of CCB was somewhat more beneficial in hypertensive patients on a high-salt diet. The overall attainment of CCB was good, and CCB is the basis of a combination of medications for hypertensive patients with many extra-antihypertensive benefits. In patients with ischemic stroke, the rational selection of drugs for standardized antihypertensive therapy should be based on the antihypertensive principles recommended in the “Chinese Hypertension Guidelines 2010”: small doses, long-acting agents, combination therapy and individualized therapy. Individualized treatment means that the treatment strategy should be determined according to individual circumstances, tolerance and individual wishes. Blood pressure management in the acute phase of ischaemic stroke In stroke with altered cerebral haemodynamics, blood pressure should be lowered with caution. In extracranial carotid artery stenosis, there is a definite impact on blood pressure lowering. As seen in the WASID study, bilateral carotid stenosis of 70% or more is associated with a high mean blood pressure lowering, which is higher than the usual target value for blood pressure lowering. In addition, for watershed infarcts in different vascular junction regions, such patients already have hypoperfused infarcts and therefore blood pressure should not be lowered too low and should be done with great caution. In conclusion, there is a correlation between infarct morphology and arterial stenosis in acute stroke, and in the acute phase of stroke, when angiography is not available, the possibility of the presence of stenosis should be determined based on the extent of the stroke infarct. Therefore, in the acute phase of stroke, blood pressure should be lowered with caution. Antihypertensive therapy and prognosis in the acute phase of stroke The effect of hypertension and antihypertensive therapy on thrombolytic therapy was observed in the Swedish SITS-ISTR Thrombolysis Study. When thrombolysis was good in all patients, multifactorial analysis revealed that high systolic blood pressure was associated with a poor prognosis and was linearly associated with symptomatic cerebral hemorrhage; however, systolic blood pressure in the range of 140-150 mmHg was associated with a good prognosis. The study concluded that as long as moderate blood pressure lowering, in the early post-thrombolytic period (7 days), did not reveal a poor prognosis for patients with previous hypertension; newly treated hypertension also seemed to show a trend toward a good prognosis. Therefore, routine antihypertensive therapy is mostly advocated clinically to be started when the disease is stable. Specific strategies to lower blood pressure in the acute phase of stroke There has been controversy about lowering blood pressure in the acute phase of stroke, and clinicians have made efforts to explore research in this area. In a study of mixed ischemia and hemorrhage, aggressive antihypertensive treatment of hypertensive patients in the acute phase of stroke was found to reduce mortality when systolic blood pressure exceeded 160 mmHg; in a study of cerebral hemorrhage, aggressive antihypertensive treatment performed within 6 hours of hemorrhage, with a target blood pressure of 140 mmHg, reduced the risk of hematoma enlargement. In the Chinese guidelines for the acute phase of ischemic stroke, different thresholds for BP lowering are recommended for different conditions, divided into: (1) general stroke patients whose systolic BP reaches 200 mmHg in the acute phase, i.e., pharmacological interventions; (2) stroke patients with thrombolysis, whose BP should be controlled to a systolic BP <180 mmHg before starting thrombolysis; (3) acute stroke with other conditions, such as severe cardiac insufficiency, aortic coarctation (3) In acute stroke with other conditions, such as severe cardiac insufficiency, aortic coarctation, or hypertensive encephalopathy, we should slowly lower the blood pressure. For secondary prevention of ischemic stroke, the target blood pressure is 140/90 mmHg and antihypertensive therapy should be attainment, combined and slow. In the acute phase of stroke, blood pressure should be lowered cautiously in stroke with cerebral hemodynamic alterations; individualized blood pressure management in different strata should be implemented according to the specific condition of the patient.