For a patient with acute ischemic stroke who is not a candidate for thrombectomy or fibrinolysis, what blood pressure treatment is appropriate?

In the case of a patient with acute ischemic stroke who is not eligible for thrombectomy or fibrinolysis, the primary consideration is the management of blood pressure in a way that does not further compromise cerebral perfusion or introduce additional risk of complications.

For patients who do not require immediate blood pressure reduction, it is generally acceptable to avoid antihypertensive treatment, particularly since modest hypertension can be a physiological response to the ischemic event and may not pose immediate risks. In fact, lowering blood pressure too aggressively in this scenario could lead to poor outcomes by reducing cerebral blood flow to already compromised brain tissue.

The approach of not initiating antihypertensive treatment aligns with current guidelines, which recommend allowing blood pressures that are not exceedingly high to remain unchanged unless they exceed certain thresholds where treatment becomes necessary to avoid end-organ dysfunction. It recognizes the body's compensatory mechanisms and the need to maintain adequate cerebral perfusion pressure.

In summary, no antihypertensive treatment is warranted for a patient with acute ischemic stroke who does not qualify for advanced interventions, reinforcing the importance of maintaining cerebral blood flow during a critical time in the clinical course of the disease.