Introduction to blood pressure lowering medication
- Medication to lower blood pressure should be considered for secondary prevention after either ischaemic or haemorrhagic stroke
- The best time to start blood pressure lowering therapy depends on several factors, including the type of stroke (ischaemic or haemorrhagic), and what co-morbidities the patient may have.
- Ongoing research aims to establish whether blood pressure lowering should be started immediately after stroke onset.
- For patients presenting within 6 hours of stroke onset due to intracerebral haemorrhage, acute blood pressure reduction to <140mmHg systolic for the first 7 days is often attempted if BP is >150mmHg systolic.
- Blood pressure is sometimes lowered acutely to facilitate thrombolysis e.g if >180/110mmHg.
- Typically thiazides, e.g. Bendroflumethiazide and/or ACE inhibitors e.g. Lisinopril, are used after stroke, although other classes of blood pressure lowering agents are often used. It is common to need several different drugs to achieve a target blood pressure.
- It is useful to have a working knowledge of their common adverse effects so that if these arise they can be attributed to the correct drug
- A target systolic blood pressure of less than 130mmHg is appropriate for most patients, although there are specific exceptions including severe extracranial vascular disease, or frailty.
- Lifestyle factors, such as reducing salt intake, weight loss, and avoiding excess alcohol also contributes to BP reduction
Reference: Royal college of Physicians Stroke Guidelines (2016).
Page last reviewed: 22 Apr 2022
