Hypertension in Stroke

SysBP≤ 220 OR diaBP ≤120

Observe unless other end-organ involvement (eg, aortic dissection, acute myocardial infarction, pulmonary edema, hypertensive encephalopathy)Treat other symptoms of stroke (eg, headache, pain, agitation, nausea, vomiting)Treat other acute complications of stroke, including hypoxia, increased intracranial pressure, seizures, or hypoglycemia

Systolic >220 OR diastolic 121 to 140

Labetalol 10 to 20 mg IV for 1 to 2 minMay repeat or double every 10 min (max dose 300 mg)ORNicardipine 5 mg/h IV infusion as initial dose; titrate to desired effect by increasing 2.5 mg/h every 5 min to max of 15 mg/hAim for a 10% to 15% reduction in BP

Diastolic >140

Nitroprusside 0.5 µg/kg per minute IV infusion as initial dose with continuous blood pressure monitoringAim for a 10% to 15% reduction in blood pressure

B. Eligible for fibrinolytic therapy

Pretreatment

Systolic >185 OR diastolic >110

Labetalol 10 to 20 mg IV for 1 to 2 minMay repeat 1 time or nitropaste 1 to 2 in

During/after treatment

1. Monitor BP

Check BP every 15 min for 2 h, then every 30 min for 6 h, and finally every hour for 16 h 

2. Diastolic >140

Sodium nitroprusside 0.5 µg/kg per minute IV infusion as initial dose and titrate to desired blood pressure 

3. Systolic >230 OR diastolic 121 to 140

Labetalol 10 mg IV for 1 to 2 min.

May repeat or double labetalol every 10 min to maximum dose of 300 mg, or give initial labetalol dose, then start labetalol drip at 2 to 8 mg/minORNicarpidine 5 mg/h IV infusion as initial dose and titrate to desired effect by increasing 2.5 mg/h every 5 min to maximum of 15 mg/h; if blood pressure is not controlled by labetalol, consider sodium nitroprusside 

4. Systolic 180 to 230 OR diastolic 105 to 120

Labetalol 10 mg IV for 1 to 2 min.

May repeat or double labetalol every 10 to 20 min to maximum dose of 300 mg, or give initial labetalol dose, then start labetalol drip at 2 to 8 mg/min