|
Blood pressure level (mm
Hg) |
Treatment |
|
A. Not
eligible for thrombolytic therapy |
| Systolic <220
OR Diastolic <120 |
Observe unless other end-organ involvement, eg,
aortic dissection, acute myocardial infarction,
pulmonary edema, hypertensive encephalopathy |
|
Treat other symptoms of stroke such as headache,
pain, agitation, nausea, and vomiting |
|
Treat other acute complications of stroke, including
hypoxia, increased intracranial pressure, seizures, or
hypoglycemia |
| Systolic >220
OR Diastolic 121-140 |
Labetalol 10-20 mg IV over 1-2 min. May repeat or double every 10 min (maximum dose 300
mg or |
|
Nicardipine 5 mg/hr IV infusion as initial dose;
titrate to desired effect by increasing 2.5 mg/hr every
5 min to maximum of 15 mg/hr |
|
Aim for a 10 percent to 15 percent reduction of blood
pressure |
| Diastolic >140 |
Nitroprusside 0.5 mcg/kg/min IV infusion as initial
dose with continuous blood pressure monitoring |
|
Aim for a 10 percent to 15 percent reduction of
blood pressure |
|
B. Eligible
for thrombolytic therapy |
| Pretreatment |
| Systolic >185
OR Diastolic >110 |
Labetalol 10-20 mg IV over 1-2 min |
|
May repeat x 1 OR nitropaste 1-2 inches |
|
During and
after treatment |
| 1. Monitor BP |
Check BP every 15 min for 2 hours, then
every 30 min for 6 hours, and then every hour for 16
hours |
| 2. Diastolic >140 |
Sodium nitroprusside 0.5 µg/kg/min IV
infusion as initial dose and titrate to desired blood
pressure |
| 3. Systolic >230
OR Diastolic 121-140 |
Labetalol 10 mg IV over 1-2 min |
|
May repeat or double labetalol every 10 min to a
maximum dose of 300 mg or give the initial labetalol
bolus and then start a labetalol drip at 2 to 8
mg/min or |
|
Nicardipine 5 mg/hr IV infusion as initial dose; |
|
Titrate to desired effect by increasing 2.5 mg/hr
every 5 min to maximum of 15 mg/hr. If BP is not
controlled by labetalol, consider sodium
nitroprusside |
| 4. Systolic 180-230
OR Diastolic 105-120 |
Labetalol 10 mg IV over 1-2 min |
|
May repeat or double labetalol every 10 to 20 min to
a maximum dose of 300 mg or give the initial labetalol
bolus and then start drip at 2 to 8
mg/min |