Antihypertensive Agents for Acute Stroke

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

Capture.PNG

 

Eligible for tPA except BP 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

BP not maintained </=185/110 mmHg, do not administer rtPA

Keep BP during and after tPA <= 180/105 mmHg:

  • Monitor BP from start of tPA
    • every 15 minutes x 2 hours
    • every 30 minutes x 6 hours
    • every hour x 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

 

Reference:

Jauch, E. C. et al. “Guidelines For The Early Management Of Patients With Acute Ischemic Stroke: A Guideline For Healthcare Professionals From The American Heart Association/American Stroke Association”. Stroke 44.3 (2013): 870-947. Web. 22 Mar. 2016.

Advertisements

Tagged: , , ,

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: