Table 9.

Potential Approaches to Arterial Hypertension in Acute Ischemic Stroke Patients Who Are Candidates for Acute Reperfusion Therapy

Patient otherwise eligible for acute reperfusion therapy except that BP is >185/110 mmHg:
  Labetalol 10–20 mg IV over 1–2 minutes, may repeat 1 time; or
  Nicardipine 5 mg/h IV, titrate up by 2.5 mg/h every 5–15 minutes, maximum 15 mg/h; when desired BP reached, adjust to maintain proper BP limits; or
  Other agents (hydralazine, enalaprilat, etc) may be considered when appropriate
If BP is not maintained at or below 185/110 mmHg, do not administer rtPA
Management of BP during and after rtPA or other acute reperfusion therapy to maintain BP at or below 180/105 mmHg:
  Monitor BP every 15 minutes for 2 hours from the start of rtPA therapy, then every 30 minutes for 6 hours, and then every hour for 16 hours
If systolic BP >180–230 mmHg or diastolic BP >105–120 mmHg:
  Labetalol 10 mg IV followed by continuous IV infusion 2–8 mg/min; or
  Nicardipine 5 mg/h IV, titrate up to desired effect by 2.5 mg/h every 5–15 minutes, maximum 15 mg/h
If BP not controlled or diastolic BP >140 mmHg, consider IV sodium nitroprusside
  • BP indicates blood pressure; IV, intravenously; and rtPA, recombinant tissue-type plasminogen activator.