OBJECTIVES: Stroke, the most common neurologic disorder and the major cause of disability and death after heart disease causing 11.8% of the total deaths worldwide, is defined as a rapidly developing clinical signs of focal disturbance of cerebral function lasting more than 24 h. This study aims to assess appropriateness of hypertension treatment in acute stroke and its adherence with the choice of medications tailored according to blood pressure readings. PATIENTS AND METHODS: This was a pilot study performed in Lebanese hospitals where medical records of ischemic stroke patients were used to collect required data. The study enrolled ischemic stroke patients older than 18 years of age, admitted to intensive care unit or internal medicine department. Patients with hemorrhagic stroke were excluded. Statistical analysis was done using IBM Statistical Package for the Social Science software. The significance level is p-value ≤ 0.05. RESULTS: A total of 146 patients (56.8% females; mean age 76.6 ±â€¯11.9) were included in the analysis. At baseline, patients had a mean ±â€¯standard deviation (SD) SBP of 160.6 (±31.3) and a mean DBP of 85.5. Labetalol and amlodipine were administered to patients with significantly higher baseline blood pressure (p < 0.001). Change in SBP from baseline after 2 h of drug administration was significantly higher with labetalol (p = 0.028 for patients eligible for reperfusion), amlodipine (p = 0.014), and nitroglycerine (p = 0.044). As for the change in SBP after 24 h, it was significantly higher with labetalol just for patients not eligible for reperfusion (p < 0.001), and amlodipine (p = 0.006). As for the change in DBP, it was significantly lower after 24 h on labetalol administration for patients not eligible for reperfusion (p < 0.001) and it was also lower 2 h after administration of ramipril (p = 0.001) and 24 h (p = 0.021). CONCLUSION: This study reveals the gap between American Stroke Association guideline recommendations and the clinical practice and states the impact of such a difference on patients' health.