A 62-year-old man with acute ischemic stroke has a blood pressure of 225/118 mmHg. He is not a candidate for thrombolysis. According to AHA/ASA guidelines, at what blood pressure threshold should antihypertensive treatment be initiated?
- A Systolic >200 mmHg or diastolic >110 mmHg
- B Systolic >180 mmHg or diastolic >100 mmHg
- C Systolic >220 mmHg or diastolic >120 mmHg ✓
- D Systolic >185 mmHg or diastolic >110 mmHg
Correct answer: C. Systolic >220 mmHg or diastolic >120 mmHg
Explanation
For patients with acute ischemic stroke who are not receiving thrombolytic therapy, antihypertensive treatment is recommended only if systolic blood pressure exceeds 220 mmHg or diastolic exceeds 120 mmHg. Lowering blood pressure too aggressively can worsen penumbral ischemia. The threshold for thrombolysis candidates is lower, at 185/110 mmHg. This distinction is frequently tested.
Reference: Harrison's Principles of Internal Medicine, 20th ed.
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