90yo wf with mild htn but prior ischemic stroke woke abruptly but late. confused+agitated for 20 min. ok p oj/could digital home bp of 189/169 be real?

Yes, Go to the ER: She may be having another stroke, i would have her evaluated asap.

189/69 REALly bad!: Scenario described is most likely due to cerebral ischemic event (tia or true stroke) which is frequently associated with exacerbation of pre-existing hypertension. This is not a nice picture. Better blood pressure & more aggressive stroke prevention measures are needed.