Castilla–Guerra L et al. – The review presents the most recent evidence on the management of hypertension in patients who have had a stroke.

• High blood pressure (BP) is the strongest risk factor for stroke.
• It is estimated that almost 50% of strokes may be attributable to hypertension.
• Both diastolic and isolated systolic hypertension are important predictors of primary or recurrent strokes, and even minor decreases in BP can reduce the risk of stroke.
• While the primary prevention of stroke through the treatment of hypertension is well established, the issue of lowering BP after a stroke has been uncertain, particularly since this might worsen cerebral perfusion if autoregulation remains chronically damaged or severe carotid artery stenosis is present.
• Furthermore, there is substantial evidence to support BP lowering for prevention of a first stroke; however, few trials have focused on antihypertensive therapy for recurrent stroke prevention.
• In fact, currently, BP management in patients with strokes remains problematic, and questions such as the choice of antihypertensive drug and by how much to reduce BP are yet to be resolved.
• Recently, the American Heart Association and American Stroke Association published updated guidelines for recurrent stroke prevention, and new recommendations on BP management have been included.