Table 3.

Management of arterial hypertension in patients with acute ischemic stroke who are candidates for fibrinolysis.

Before fibrinolysis
If SBP >185 mm Hg or DBP >110 mm Hg
Labetalol 10–20 mg IV over 1–2 min (may repeat once)
or
Nicardipine infusion at 5–15 mg/h
If BP controlled, administer fibrinolysis
If BP still >185/110 mm Hg, do NOT proceed with fibrinolysis
After fibrinolysis
If SBP 180–230 mm Hg or DBP 105–120 mm Hg
Labetalol 10–20 mg IV over 1–2 min,  may repeat every 10–20 min up to 300 mg over 24 h
or
Labetalol 10–20 mg IV followed by infusion at 2–8 mg/min
or
Nicardipine infusion at 5–15 mg/h
If SBP >230 mm Hg or DBP >120 mm Hg
Sodium nitroprusside infusion at 0.5–3 mcg/kg/min (doses of up to 10 mcg/kg/min can be safely administered for up to 10 min)

This protocol also applies to other forms of reperfusion therapy apart from intravenous rt-PA.

BP, blood pressure; SBP, systolic blood pressure; DBP, diastolic blood pressure.