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Hence, nuances on how to manage high BP are likely, including whether different interventions are needed for different causes, the type and timing of the drug, how quickly BP is lowered, and the collateral effects of the drug, including on cerebral perfusion and platelets. Specific scenarios are also important, including when to lower BP before, during, and after intravenous thrombolysis and endovascular therapy\/thrombectomy, when it may be necessary to raise BP, and when antihypertensive drugs taken before stroke should be restarted. This narrative review addresses these and other questions. Although further large trials are ongoing, it is increasingly likely that there is no simple answer. Different subgroups of patients may need to have their BP lowered (eg, before or after thrombolysis), left alone, or elevated.<\/jats:p>","DOI":"10.1161\/strokeaha.121.036143","type":"journal-article","created":{"date-parts":[[2022,3,16]],"date-time":"2022-03-16T05:00:17Z","timestamp":1647406817000},"page":"1074-1084","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":100,"title":["Blood Pressure Management for Ischemic Stroke in the First 24 Hours"],"prefix":"10.1161","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2734-5132","authenticated-orcid":true,"given":"Philip M.","family":"Bath","sequence":"first","affiliation":[{"name":"Stroke Trials Unit, Mental Health and Clinical Neuroscience, University of Nottingham, United Kingdom (P.M.B.)."},{"name":"Stroke, Nottingham University Hospitals NHS Trust, United Kingdom (P.M.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6105-1720","authenticated-orcid":true,"given":"Lili","family":"Song","sequence":"additional","affiliation":[{"name":"The George Institute China at Peking University Health Science Center, Beijing (L.S.)."},{"name":"Faculty of Medicine, George Institute for Global Health, University of New South Wales, Sydney, Australia (L.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3247-3123","authenticated-orcid":true,"given":"Gisele S.","family":"Silva","sequence":"additional","affiliation":[{"name":"Neurology, Federal University of S\u00e3o Paulo (UNIFESP) and Hospital Israelita Albert Einstein, Brazil (G.S.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7426-3650","authenticated-orcid":true,"given":"Eva","family":"Mistry","sequence":"additional","affiliation":[{"name":"Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (E.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9711-3340","authenticated-orcid":true,"given":"Nils","family":"Petersen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Divisions of Vascular Neurology and Neurocritical Care, Yale School of Medicine, New Haven (N.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0640-3797","authenticated-orcid":true,"given":"Georgios","family":"Tsivgoulis","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (G.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0911-8999","authenticated-orcid":true,"given":"Mikael","family":"Mazighi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Lariboisiere Hospital, and Interventional Neuroradiology, Fondation Rothschild Hospital, University of Paris, INSERM 1148, FHU Neurovasc, France (M.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7962-8751","authenticated-orcid":true,"given":"Oh Young","family":"Bang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (O.Y.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4312-4778","authenticated-orcid":true,"given":"Else Charlotte","family":"Sandset","sequence":"additional","affiliation":[{"name":"Stroke Unit, Department of Neurology, Oslo University Hospital, Norway (E.C.S.)."},{"name":"The Norwegian Air Ambulance Foundation, Oslo (E.C.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000211"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/23969873211012133"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1985.04060090081018"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1985.04060090082019"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1985.04060090084020"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.723874"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.021254"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.22.4.527"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(98)07614-4"},{"key":"e_1_3_3_11_2","first-page":"72","article-title":"Why is blood pressure in acute ischaemic stroke associated with a poor outcome? 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