A 66-year-old woman presents 80 minutes after sudden onset of right-sided weakness and aphasia. CT head excludes haemorrhage, NIHSS score is 14, and she fulfills all other criteria for intravenous thrombolysis. Her blood pressure is 196/118 mmHg. What is the required blood pressure target before administering alteplase?
- A Below 220/120 mmHg, with no medication needed
- B Below 160/100 mmHg, using oral amlodipine
- C Below 185/110 mmHg, using intravenous labetalol or nicardipine ✓
- D Below 140/90 mmHg within 10 minutes, using sublingual nifedipine
Correct answer: C. Below 185/110 mmHg, using intravenous labetalol or nicardipine
Explanation
Before intravenous thrombolysis in acute ischemic stroke, blood pressure must be lowered to below 185/110 mmHg and kept below 180/105 mmHg for 24 hours afterwards, using short-acting parenteral agents such as labetalol or nicardipine. The permissive threshold of 220/120 applies only to patients who are not receiving reperfusion therapy. Oral and sublingual agents cause unpredictable drops and are inappropriate, and excessive lowering risks extending the penumbra.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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