Ischemic Stroke, No Reperfusion Therapy

BP Level

·         SBP > 220 mm Hg or DBP>120 mm Hg

Target BP

·         Reduce BP by 15% - 25% within 24 hours

Recommended IV antihypertensive options

·         Nicardipine 5 mg/hr; titrate up by 2.5 mg/hr every 5-15 minutes to a maximum of 15 mg/hr until desired BP achieved.

·         Labetolol, 10 mg followed by continuous infusion at 2-8 mg/min

·         Consider nitroprusside if resistant.  Start at 0.3 mcg/kg/min and titrate slowly.

Ischemic Stroke with Reperfusion Therapy

BP Level

·         SBP > 185 mmHg or DBP > 110 mmHg

Target BP

·         SBP > 185 mmHg or DBP > 110 mmHg

Recommended IV antihypertensive options

·         Nicardipine 5 mg/hr; titrate up by 2.5 mg/hr every 5-15 minutes to a maximum of 15 mg/hr until desired BP achieved.

·         Labetolol, 10 mg followed by continuous infusion at 2-8 mg/min

·         Other agents (hydralazine, enalapril) when appropriate

Hemorrhage Stroke with ICH

BP Level

·         SBP > 200 mmHg or MAP > 150 mmHg: Aggressive reduction with continuous IV therapy

·         If increased ICP suspected and SBP > 180 mm Hg or MAP > 130 mmHg:  Intermittent or continuous IV therapy while maintaining CPP at ≥ 60 mmHg

·         SBP > 180 mmHg or MAP > 130 mmHg and no evidence of elevated ICP: Consider intermittent or continuous IV therapy to achieve moderate BP reduction

Target BP

·         BP < 160/90 mm Hg or MAP < 110 mmHg

Recommended IV antihypertensive options

·         Nicardipine or Labetolol

SAH

BP Level

·         Unclear

·       One prehospital study suggested SBP < 160 mmHg

Target BP

·         Unclear

Recommended IV antihypertensive options

·         Administer short acting continuous intravenous infusions of Nicardipine, Labetolol, Esmolol