Version May 2024
| Patient otherwise eligible for acute reperfusion therapy except that blood pressure is >185/110 mmHg* |
| Labetalol 10 to 20 mg intravenously over 1 to 2 minutes, may repeat one time; or |
| Nicardipine 5 mg/hour intravenously, titrate up by 2.5 mg/hour every 5 to 15 minutes, maximum 15 mg/hour; when desired blood pressure reached, adjust to maintain proper blood pressure limits; or |
| Clevidipine 1 to 2 mg/hour intravenously, titrate by doubling the dose every 2 to 5 minutes, maximum 21 mg/hour, until desired blood pressure reached¶; or |
| Other agents (hydralazine, enalaprilat, etc) may also be considered |
| If blood pressure is not maintained at or below 185/110 mmHg, do not administer alteplase |
| Management to maintain blood pressure at or below 180/105 mmHg during and after acute reperfusion therapy* |
| Monitor blood pressure every 15 minutes for 2 hours from the start of rtPA therapy, then every 30 minutes for 6 hours, and then every hour for 16 hours |
| If systolic blood pressure is >180 to 230 mmHg or diastolic is >105 to 120 mmHg: |
| Labetalol 10 mg intravenously followed by continuous infusion 2 to 8 mg/min; or |
| Nicardipine 5 mg/hour intravenously, titrate up to desired effect by 2.5 mg/hour every 5 to 15 minutes, maximum 15 mg/hour; or |
| Clevidipine 1 to 2 mg/hour intravenously, titrate by doubling the dose every 2 to 5 minutes, maximum 21 mg/hour, until desired blood pressure reached¶ |
| If blood pressure is not controlled or diastolic blood pressure >140 mmHg, consider intravenous sodium nitroprusside |
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