11
Treatment
Table 7. Potential Approaches to Arterial Hypertension in
Acute Ischemic Stroke Patients Who Are Candidates
for Acute Reperfusion Therapy
Î Patient otherwise eligible for acute reperfusion therapy except that
BP is >185/110 mm Hg:
• 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 q 5-15 min, 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
Î If BP is not maintained ≤185/110 mm Hg, do NOT administer rtPA
Î Management of BP during and after rtPA or other acute reperfusion
therapy to maintain BP ≤180/105 mm Hg:
• Monitor BP q 15 min for 2 hours from the start of rtPA therapy, then q 30 min
for 6 hours, and then qh for 16 hours
Î If systolic BP >180-230 mm Hg or diastolic BP >105-120 mm Hg:
• 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 q 5-15 min,
maximum 15 mg/h
Î If BP not controlled or diastolic BP >140 mm Hg, consider IV sodium
nitroprusside
General Supportive Care and Treatment of Acute
Complications
Î Provide airway support and ventilatory assistance for patients with
acute stroke who have decreased consciousness or who have bulbar
dysfunction that causes compromise of the airway (I-C).
Î Provide supplemental oxygen to maintain oxygen saturation >94% (I-C).
Î Supplemental oxygen is NOT recommended in nonhypoxic patients
with acute ischemic stroke (III-B).
Î Identify and treat sources of hyperthermia (temperature >38°C),
and administer antipyretic medications to lower temperature in
hyperthermic patients with stroke (I-C).
Î Cardiac monitoring is recommended to screen for atrial fibrillation
and other potentially serious cardiac arrhythmias that would
necessitate emergency cardiac interventions. Cardiac monitoring
should be performed for at least the first 24 hours (I-B).
