It is commonly assumed that blood pressure is significantly elevated after stroke, resulting in post-stroke hypertension. However, post-acute stroke blood pressure levels have not been systematically compared with actual pre-onset blood pressure levels; additional evidence suggests that the risks and benefits of antihypertensive therapy for acute stroke may differ between the two patient groups: ischemic stroke and primary intracranial hemorrhage, and Urs Fischer from the University of Oxford compared acute and pre-onset blood pressure levels. The results were published online in Lancet Neurol on February 28, 2014. The authors recorded basal blood pressure in patients with ischemic stroke and acute intracranial hemorrhage in Oxfordshire for 10 years prior to onset and compared it to post-acute blood pressure levels. The median number of measurements of blood pressure before onset was 17 per patient. The results showed that in patients with ischemic stroke, 1) the first post-onset acute systolic blood pressure was much lower than in patients with intracranial hemorrhage; 2) the first post-onset acute systolic blood pressure level increased less in patients with ischemic stroke than before onset; and 3) the blood pressure decreased slightly within 24 hours after onset. In contrast to ischemic stroke, 1, the mean first systolic blood pressure in patients with intracranial hemorrhage is significantly higher than the pre-onset level, 2, and decreases significantly within 24 hours; 3, the mean systolic blood pressure is already significantly elevated in the days and weeks before the onset of intracranial hemorrhage. Thus, the first acute sphygmomanometer recording after primary intracranial hemorrhage is more likely to be the highest recorded level than in ischemic stroke; the highest systolic blood pressure observed within 90 minutes of the onset of intracranial hemorrhage in patients within 3 hours of the onset of the hemorrhage is higher on average than the highest blood pressure before the onset of the hemorrhage. Systolic blood pressure was also already significantly elevated in the days and weeks before the onset of intracranial hemorrhage, especially in deep and posterior hemorrhage; in contrast, systolic blood pressure in patients with ischemic stroke was not elevated immediately before the onset of the most recent stroke. In conclusion this article gives us the following hints 1. Significantly lower blood pressure after stroke does not provide the same risk and benefit in both diseases providing potential explanations; 2. It provides some insight into the design of our future experiments, which should take into account the pre-onset blood pressure level during the analysis; 3. Consistent blood pressure control is necessary for the prevention of intracranial hemorrhage.