Emergency Administration of Anti-HTN agents should be withheld unless the diastolic BP is >120 mm Hg or unless the systolic BP is >220 mm Hg.
Patient is eligible for IV rtPA or other acute reperfusion intervention. BP should be <185/110 mm Hg. If not give:
Labetalol 10 - 20 mg IV x 1 - 2 min, may repeat x 1.
OR
Nitropaste 1 - 2 inches
OR
Nicardipine infusion, 5 mg/h, titrate up by 2.5 mg/h at 5 - 15 min intervals, maximum dose 15 mg/h; when desired BP attained, reduce to 3 mg/h
If BP does not decline and remains >185/110 mm Hg, do not adminster rtPA
BP control: Keep BP 160/90 (MAP: 110) or decrease by 15%. Check Pt. clinically.
CPP >60 - 80
Do not use:
Sodium nitroprusside
NTG
Hydralazine
Enalaprilat
Ideal drug to use: ▼ BP, ▼ ICP, ▲ CPP = sodium thiopental.
Nicardipine is better than labetalol
Management of BP during and after treatment with rtPA or other acute reperfusion intervention
Monitor BP q15 min during treatment and then q15 min x 2 hrs after treatment, then q30 min x 6 hrs, and then q1hr x 16 hrs
SBP 180 - 230 mm Hg or DBP 105 - 120 mm Hg
Labetalol 10 mg IV x 1 - 2 min, may repeat q10 - 20 min, max dose of 300 mg.
OR
Labetalol 10 mg IV followed by an infusion at 2 - 8 mg/min
SBP >230 mm Hg or DPB 121 - 140 mm Hg
Labetalol 10 mg IV x 1 - 2 min, may repeat q10 - 20 min, max dose of 300 mg
OR
Labetalol 10 mg IV followed by an infusion at 2 - 8 mg/min
OR
Nicardipine infusion, 5 mg/h, titrate up to desired effect by increasing 2.5 mg/h q5 min to maximum strength of 15 mg/h
If BP not controlled, consider sodium nitroprusside.
After IV tPA, BP should be maintained <180/105 for 24 hours