Elevated blood pressure is common at the time of presentation among patients with ischemic stroke, occurring in two-thirds to three-quarters of cases.1,2 The early hypertension that follows ischemic stroke often reflects undiagnosed or undertreated chronic hypertension. However, in the great preponderance of patients, an early hypertensive response to brain ischemia is an important contributing factor, partially explained by neuroendocrine response to physiologic stress. This initial hypertensive response is self-limiting, most marked in the first few hours following the onset of cerebral ischemia and resolving over several days. Within the first 24 hours after stroke, blood pressure spontaneously declines by about one-quarter in most patients.3
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