Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED)

Inclusion Criteria:

• Adult (age ≥18 years)
• A clinical diagnosis of acute ischaemic stroke confirmed by brain imaging
• Able to receive treatment within 4.5 hours after the definite time of onset ofsymptoms
• Have a systolic BP ≤185 mmHg
• Provide informed consent (or via an appropriate proxy, according to localrequirements) Specific criteria for arm [A] of low-dose vs standard-dose rtPA (Recruitment completed inAugust 2015.):
• Able to receive either low-dose or standard-dose rtPA Specific criteria for arm [B] of intensive BP lowering vs guideline recommended BP control
• Patient will or has received thrombolysis treatment with rtPA, either randomised dosewithin the trial or physician decided dose rtPA outside of the trial
• Sustained elevated systolic BP level, defined as 2 readings ≥ 150 mmHg
• Able to commence intensive BP lowering treatment within 6 hours of stroke onset
• Able to receive either immediate intensive BP lowering or conservative BP management

Exclusion Criteria:

• Unlikely to potentially benefit from the therapy (e.g. advanced dementia), or a veryhigh likelihood of death within 24 hours of stroke onset.
• Other medical illness that interferes with outcome assessments and follow-up [knownsignificant pre-stroke disability (mRS scores 2-5)].
• Specific contraindications to rtPA (Actilyse) or any of the blood pressure agents tobe used.
• Participation in another clinical trial involving evaluation of pharmacologicalagents.
• Need for following concomitant medication, including phosphodiesterase inhibitors andmonoamine oxidase inhibitors.