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Post-Stroke – Antihypertensive Initiation Timing — SCE Neurology MCQ

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HardCerebrovascular DiseasePost-Stroke – Antihypertensive Initiation TimingSCE Neurology

A 55-year-old man with a recent non-disabling ischaemic stroke has a blood pressure of 155/92 mmHg at 2 weeks post-event. His pre-stroke BP was not documented. He is not on antihypertensive therapy. According to NICE, when should antihypertensive therapy be initiated after ischaemic stroke?

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Correct answer: D — After the hyperacute phase (typically 1–2 weeks post-stroke) once the patient is medically and neurologically stable

The best answer is “After the hyperacute phase (typically 1–2 weeks post-stroke) once the patient is medically and neurologically stable”. UK stroke guidance supports urgent vascular imaging and reperfusion selection, short-course dual antiplatelet therapy for eligible minor stroke or high-risk TIA, decompression for life-threatening swelling, and secondary prevention matched to mechanism. The alternatives “Immediately on admission, after specialist assessment, when the phenotype supports it, within the relevant UK pathway”, “After 3 months, when the phenotype supports it, within the relevant UK pathway, after excluding important mimics”, “if BP remains >180/110 at 6 months, within the relevant UK pathway, after excluding important mimics”, “Antihypertensives are contraindicated after stroke, after excluding important mimics, after specialist assessment, when the phenotype supports it” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: National Clinical Guideline for Stroke: acute care: https://www.strokeguideline.org/chapter/acute-care/