Rapid reduction of BP, even to lower levels within the hypertensive range, can be detrimental. For all other acute ischemic stroke patients, the advantage of lowering BP early to reduce death and dependency is uncertain,S9.4.2-4 S9.4.2-9 but restarting antihy- pertensive therapy to improve long-term BP control is reason- able after the first 24 hours for patients who have preexisting hypertension and are neurologically stable.S9.4.2-4,S9.4.2-5,S9.4.2-14 Figure 8 is an algorithm on management of hypertension in patients with acute ischemic stroke. Recommendation-Specific Supportive Text 1. These BP cutoffs correspond to study inclusion criteria in pivotal clinical trials of intravenous thrombolysis for acute ischemic stroke.S9.4.2-1 2. In a large observational study of patients with acute ischemic stroke who received intravenous tissue-type plasminogen activator, high BP during the initial 24 hours was linked to greater risk of symptomatic 3. For the goal of antihypertensive therapy, see Section 8.1.5. 4. Extreme arterial hypertension is detrimental because it can lead to encephalopathy, cardiac compromise, and Recommendations for Management of Hypertension in Patients With Acute Ischemic Stroke (Continued) COR LOE Recommendations Figure 8. Management of hypertension in patients with acute ischemic stroke. Colors correspond to Class of Recommendation in Table 1. BP indicates blood pressure; DBP, diastolic blood pressure; IV, intravenous; and SBP, systolic blood pressure. renal damage. However, hypotension, especially when too rapidly achieved, is potentially harmful because it abruptly reduces perfusion to multiple organs, including the brain. as well as systematic re- views and meta-analyses,S9.4.2-6 S9.4.2-8 indicate that antihy- pertensive agents reduce BP during the acute phase of an ischemic stroke but do not confer benefit with regard to short- and long-term dependency and mortality rate. 