Intensive blood pressure control reduced the risk of intracranial hemorrhage without increasing the risk of death or disability in patients with acute ischemic stroke receiving intravenous thrombolysis, according to a trial published in the Lancet. Previous studies raised concern that quickly reducing blood pressure might worsen cerebral ischemia in these patients.

Within 6 hours of acute ischemic stroke onset, 2196 patients with a systolic blood pressure of 150 mm Hg or more were randomly assigned to receive intensive blood pressure lowering (systolic target, 130-140 mm Hg ?1 hour) or guideline-recommended blood pressure lowering (systolic target, <180 mm Hg) for up to 72 hours after intravenous thrombolysis.

Functional status at 90 days did not differ between groups. However, in the intensive group, only 14.8% of patients had any intracranial hemorrhage compared with 18.7% in the guideline group. Rates of serious adverse events were similar between groups.

Due to the lack functional improvement, the findings may not support a shift to intensive blood pressure lowering among patients with mild to moderate acute ischemic stroke, according to the authors.