{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:01:16Z","timestamp":1793318476355,"version":"4.5.0"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Hypertens Res"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Hypertension is the primary modifiable risk factor for both ischemic stroke and intracerebral hemorrhage (ICH), yet recommendations for blood pressure (BP) management vary across contemporary guidelines. This narrative review compares BP targets and therapeutic strategies in the 2025 American Heart Association (AHA), 2024 European Society of Cardiology (ESC), 2023 European Society of Hypertension (ESH), and 2025 Japanese Society of Hypertension (JSH) guidelines, with emphasis on acute and chronic phases of ischemic stroke and ICH. In acute ischemic stroke without reperfusion therapy, all four guidelines discourage routine BP lowering unless systolic BP (SBP) is \u2265220\u2009mmHg or diastolic BP\u2009\u2265\u2009120 (110)\u2009mmHg, and then recommend only modest reductions of about 15% within 24\u2009hours. For patients receiving IV thrombolysis or mechanical thrombectomy, the guidelines converge on pre-treatment BP&lt;185\/110\u2009mmHg and maintenance &lt;180\/105\u2009mmHg during the first 24\u2009hours, with JSH specifying micro-infusion calcium channel blockers as preferred agents. In chronic ischemic stroke, AHA, ESH, and JSH generally endorse BP&lt;130\/80\u2009mmHg, whereas ESC prioritizes an SBP range of 120-9\u2009mmHg. For acute ICH, all guidelines support rapid but carefully titrated SBP reduction toward approximately 140\u2009mmHg, while emphasizing avoidance of overshoot, large variability, and excessive early declines, particularly when baseline SBP exceeds 220\u2009mmHg in the AHA and ESC guidelines. Long-term after ICH, targets of &lt;130\/80\u2009mmHg are widely recommended. Thiazide diuretics, ACE inhibitors, and angiotensin receptor blockers remain foundational for secondary prevention, with calcium channel blockers central to acute parenteral therapy and \u03b2-blockers reserved for specific indications. Despite regional nuances, the guidelines converge on conservative acute management in ischemic stroke, proactive early lowering in ICH, and intensive long-term BP control as the global benchmark for secondary cerebrovascular prevention.<\/jats:p>","DOI":"10.1038\/s41440-025-02517-0","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T06:45:05Z","timestamp":1767941105000},"page":"984-987","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Blood pressure management in stroke: comparative review of the 2025 AHA\/ACC\/AANP\/ACPM\/AGS\/AMA\/ASPC\/NMA\/PCNA\/SGIM, 2024 ESC, 2023 ESH, and 2025 JSH guidelines"],"prefix":"10.1038","volume":"49","author":[{"given":"Masatoshi","family":"Koga","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"2517_CR1","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1016\/S0140-6736(19)30038-8","volume":"393","author":"CS Anderson","year":"2019","unstructured":"Anderson CS, Huang Y, Lindley RI, Chen X, Arima H, Chen G, et al. Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke (ENCHANTED): an international, randomised, open-label, blinded-endpoint, phase 3 trial. Lancet. 2019;393:877\u201388.","journal-title":"Lancet"},{"key":"2517_CR2","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1001\/jama.2013.282543","volume":"311","author":"J He","year":"2014","unstructured":"He J, Zhang Y, Xu T, Zhao Q, Wang D, Chen CS, et al. Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke: the CATIS randomized clinical trial. JAMA. 2014;311:479\u201389.","journal-title":"JAMA"},{"key":"2517_CR3","doi-asserted-by":"publisher","first-page":"I","DOI":"10.1177\/23969873221100032","volume":"7","author":"J Dawson","year":"2022","unstructured":"Dawson J, Bejot Y, Christensen LM, De Marchis GM, Dichgans M, Hagberg G, et al. European Stroke Organisation (ESO) guideline on pharmacological interventions for long-term secondary prevention after ischaemic stroke or transient ischaemic attack. Eur Stroke J. 2022;7:I\u2013II.","journal-title":"Eur Stroke J"},{"key":"2517_CR4","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1016\/S0140-6736(13)60852-1","volume":"382","author":"Group SPSS","year":"2013","unstructured":"Group SPSS, Benavente OR, Coffey CS, Conwit R, Hart RG, McClure LA, et al. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet. 2013;382:507\u201315.","journal-title":"Lancet"},{"key":"2517_CR5","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1001\/jamaneurol.2019.2167","volume":"76","author":"K Kitagawa","year":"2019","unstructured":"Kitagawa K, Yamamoto Y, Arima H, Maeda T, Sunami N, Kanzawa T, et al. Effect of Standard vs Intensive Blood Pressure Control on the Risk of Recurrent Stroke: A Randomized Clinical Trial and Meta-analysis. JAMA Neurol. 2019;76:1309\u201318.","journal-title":"JAMA Neurol"},{"key":"2517_CR6","doi-asserted-by":"publisher","first-page":"2355","DOI":"10.1056\/NEJMoa1214609","volume":"368","author":"CS Anderson","year":"2013","unstructured":"Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013;368:2355\u201365.","journal-title":"N Engl J Med"},{"key":"2517_CR7","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1056\/NEJMoa1603460","volume":"375","author":"AI Qureshi","year":"2016","unstructured":"Qureshi AI, Palesch YY, Barsan WG, Hanley DF, Hsu CY, Martin RL, et al. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med. 2016;375:1033\u201343.","journal-title":"N Engl J Med"},{"key":"2517_CR8","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1016\/S0140-6736(01)06178-5","volume":"358","author":"PROGRESS Collaborative Group","year":"2001","unstructured":"Group PC. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001;358:1033\u201341.","journal-title":"Lancet"},{"key":"2517_CR9","doi-asserted-by":"publisher","first-page":"1859","DOI":"10.1038\/s41440-025-02183-2","volume":"48","author":"T Maeda","year":"2025","unstructured":"Maeda T, Ohya Y, Ishida S, Inoue Y, Fujii T, Sakamoto Y, et al. Optimal blood pressure target for patients with prior stroke: A systematic review and meta-analysis. Hypertens Res. 2025;48:1859\u201369.","journal-title":"Hypertens Res"}],"container-title":["Hypertension Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41440-025-02517-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41440-025-02517-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41440-025-02517-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T23:01:57Z","timestamp":1772665317000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41440-025-02517-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,9]]},"references-count":9,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["2517"],"URL":"https:\/\/doi.org\/10.1038\/s41440-025-02517-0","relation":{},"ISSN":["0916-9636","1348-4214"],"issn-type":[{"value":"0916-9636","type":"print"},{"value":"1348-4214","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,9]]},"assertion":[{"value":"14 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 November 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 November 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 January 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Koga report honoraria from Daiichi Sankyo, and research grants from Daiichi Sankyo and Boston Scientific Japan.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}