Methodology: 4/5
Usefulness: 2/5

Liu L, et al. BMJ. 2023 Oct 9;383:e076448. 

Question: Do early vs delayed blood pressure management in patients with mild-moderate acute ischemic strokes decrease death or dependency at 90 days?
Methods: Randomization to early (24 hrs) vs delayed treatment (after 7 days) of blood pressure. They monitored BP at baseline, during admission and post discharge.
Findings: At 90 days, 12% of early treatment group vs 10.5% of delayed treatment group had primary composite outcome of death and dependency.
Limitations: They excluded important patients; severe strokes, atrial fibrillation, uncontrolled HTN at presentation. Blood pressure management prior to randomization (<24 hrs) was not accounted for.

Interpretation: This solidifies prior practice of allowing patients’ BP to auto-regulate. It is a reminder to treat uncontrolled hypertension in hemorrhagic strokes and patients undergoing intervention.

Dr. Pascale King

JC Supervisor: Dr. Vaillancourt