A 68-year-old hypertensive woman presents within 3 hours of onset of right hemiplegia and aphasia. CT head shows no hemorrhage. BP is 188/102 mmHg. She has no contraindications to thrombolysis. According to AHA/ASA guidelines, the BP threshold that must be achieved BEFORE IV alteplase can be administered is:

• A < 185/110 mmHg ✓
• B < 200/120 mmHg
• C < 160/100 mmHg
• D < 140/90 mmHg

Explanation

Per AHA/ASA 2019 Acute Ischemic Stroke Guidelines, BP must be lowered to <185/110 mmHg before and maintained <180/105 mmHg for 24 hours after IV alteplase administration. Antihypertensive agents (labetalol, nicardipine) are used cautiously to achieve this target. Aggressive lowering below 140/90 mmHg pre-thrombolysis may harm penumbral tissue by reducing perfusion pressure in autoregulation-impaired ischemic brain. The 185/110 threshold is specific to the thrombolysis window and differs from post-stroke BP management targets.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.