European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage

Sandset, Else Charlotte; Anderson, Craig S; Bath, Philip M; Christensen, Hanne; Fischer, Urs; Manning, Lisa S; G?secki, Dariusz; Lal, Avtar; Sacco, Simona; Steiner, Thorsten; Tsivgoulis, Georgios

Abstract

Introduction: The optimal blood pressure (BP) management in acute ischaemic stroke (AIS) and acute intracerebral haemorrhage (ICH) remains controversial. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist physicians in their clinical decisions regarding BP management in acute stroke.
Methods: The guidelines were developed according to the ESO standard operating procedure and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and make specific recommendations. Expert consensus statements are provided where insufficient evidence was available to provide recommendations based on the GRADE approach.
Results: Despite several large randomised-controlled clinical trials, quality of evidence is generally low due to inconsistent results of the effect of blood pressure lowering in AIS. Still, early and modest blood pressure control (avoiding blood pressure levels >180/105mmHg) is recommended in AIS patients undergoing reperfusion therapies. There is more high-quality randomised evidence for BP lowering in acute ICH, where intensive blood pressure lowering is recommended rapidly after hospital presentation with the intent to improve recovery by reducing haematoma expansion. These guidelines provide further recommendations on blood pressure thresholds and for specific patient subgroups.
Conclusions: There is ongoing uncertainty as to the most appropriate blood pressure management in AIS and ICH. Further randomised-controlled clinical trials are needed to inform decision making on thresholds, timing and strategy of blood pressure lowering in different acute stroke patient subgroups.

Citation

Sandset, E. C., Anderson, C. S., Bath, P. M., Christensen, H., Fischer, U., Manning, L. S., …Tsivgoulis, G. (2021). European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage. European Stroke Journal, 6(2), XLVIII-LXXXIX. https://doi.org/10.1177/23969873211012133

• Journal Article Type: Article
• Acceptance Date: Apr 5, 2021
• Online Publication Date: May 11, 2021
• Publication Date: Jun 1, 2021
• Deposit Date: Apr 16, 2021
• Publicly Available Date: May 11, 2021
• Journal: European Stroke Journal
• Electronic ISSN: 2396-9873
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 6
• Issue: 2
• Pages: XLVIII-LXXXIX
• DOI: https://doi.org/10.1177/23969873211012133
• Keywords: ischaemic stroke; intracerebral haemorrhage; blood pressure; hypertension; guidelines; recommendations; antihypertensive; blood pressure lowering
• Public URL: https://nottingham-repository.worktribe.com/output/5469302
• Publisher URL: https://journals.sagepub.com/doi/full/10.1177/23969873211012133