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Should antihypertensive therapy be considered friend or foe in patients with stroke? The answer may well depend on when such therapy is used. Treatment of mild hypertension may substantially reduce the risk for, and the incidence of, stroke, especially in elderly men and women. However, within the setting of acute stroke, aggressive treatment of high BP is unwarranted but apparently overused, delegates were told at the American Heart Association’s 23rd Annual Joint Conference on Stroke and Cerebral Circulation [ Orlando, US; February 1998 ]. Use of antihypertensives may adversely affect acute outcome and recovery, and findings from a small case-control study indicate that use of angiotensin-converting enzyme (ACE) inhibitors may actually impair stroke recovery.