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Acute Ischemic Stroke (AIS)
COR LOE
Recommendations
I B-NR Adults with AIS and elevated BP who are eligible for treatment
with intravenous tissue plasminogen activator should have
their BP slowly lowered to less than 185/110 mm Hg before
thrombolytic therapy is initiated.
I B-NR In adults with an AIS, BP should be less than 185/110 mm Hg
before administration of intravenous tissue plasminogen activator
and should be maintained below 180/105 mm Hg for at least the
first 24 hours aer initiating drug therapy.
IIa B-NR Starting or restarting antihypertensive therapy during
hospitalization in patients with BP greater than 140/90 mm Hg
who are neurologically stable is safe and reasonable to improve
long-term BP control, unless contraindicated.
IIb C-EO In patients with BP of 220/120 mm Hg or higher who did not
receive intravenous alteplase or endovascular treatment and
have no comorbid conditions requiring acute antihypertensive
treatment, the benefit of initiating or reinitiating treatment of
hypertension within the first 48 to 72 hours is uncertain. It might
be reasonable to lower BP by 15% during the first 24 hours aer
onset of stroke.
III: No
Benefit
A In patients with BP less than 220/120 mm Hg who did not
receive intravenous thrombolysis or endovascular treatment
and do not have a comorbid condition requiring acute
antihypertensive treatment, initiating or reinitiating treatment
of hypertension within the first 48 to 72 hours aer an acute
ischemic stroke is not effective to prevent death or dependency.
