A second- ary endpoint in 1 RCT and an overview of data from 4 RCTs indicate that intensive BP reduction, versus BP- lowering guideline treatment, is associated with greater functional recovery at 3 months.S9.4.1-1,S9.4.1-7 2. RCT data have suggested that immediate BP lowering (to <140/90 mm Hg) within 6 hours of an acute ICH was feasible and safe,S9.4.1-1,S9.4.1-8,S9.4.1-9 may be linked to greater attenuation of absolute hematoma growth at 24 and might be associated with modestly better functional recovery in survivors.S9.4.1-1,S9.4.1-7 However, a that examined immediate BP lowering within 4.5 hours of an acute ICH found that treatment to achieve a target SBP of 110 to 139 mm Hg did not lead to a lower rate of death or disability than standard reduction to a target of 140 to 179 mm Hg. Moreover, there were significantly more renal adverse events within 7 days af- ter randomization in the intensive-treatment group than in the standard-treatment group.S9.4.1-2 Put together, nei- ther of the 2 key trialsS9.4.1-1,S9.4.1-2 evaluating the effect of lowering SBP in the acute period after spontaneous ICH met their primary outcomes of reducing death and severe disability at 3 months. 9.4.2. Acute Ischemic Stroke Recommendations for Management of Hypertension in Patients With Acute Ischemic Stroke References that support recommendations are summarized in Online Data Supplement 42. COR LOE Recommendations I B-NR 1. Adults with acute ischemic stroke and elevated BP who are eligible for treatment with intravenous tissue plasminogen activator should have their BP slowly lowered to less than 185/110 mm Hg before thrombolytic therapy is initiated.S9.4.2-1,S9.4.2-2 I B-NR 2. 