How aggressive should BP control be?

Patients with AIS who have elevated BP and are otherwise eligible for IVT should have their SBP lowered to <185 mm Hg and DBP <110 mm Hg before IVT therapy is initiated to reduce hemorrhagic complications (COR 1, LOE B-NR). BP should be maintained at <180/105 mm Hg for at least the first 24 hours after IVT treatment (COR 1, LOE B-R). In patients with mild to moderate severity AIS who have been treated with IVT, intensive SBP reduction (target of <140 mm Hg compared with <180 mm Hg) should not be used routinely because it is not associated with an improvement in functional outcome (COR 3: No Benefit, LOE B-R). In patients with AIS with LVO of the anterior circulation who have been successfully recanalized by EVT (mTICI 2b, 2c, or 3) and without other indication for BP management target, intensive SBP reduction target of <140 mm Hg for the first 72 hours is harmful and should be avoided (COR 3: Harm, LOE A).

Source: 2026 AHA/ASA Guideline · §4.3 (Blood pressure management in acute ischemic stroke)