A 68-year-old man presents with sudden onset left-sided weakness 90 minutes ago. NIHSS is 14. Non-contrast CT brain is normal. BP is 178/96 mmHg. No contraindications to thrombolysis are identified. What is the appropriate BP management before IV alteplase administration?
- A Lower BP to < 140/90 mmHg using IV labetalol before giving alteplase
- B Alteplase can be given regardless of BP level up to 220/120 mmHg
- C Treat BP only if > 185/110 mmHg; target < 185/110 mmHg before and during alteplase infusion ✓
- D Lower BP to < 160/90 mmHg before proceeding with any reperfusion therapy
Correct answer: C. Treat BP only if > 185/110 mmHg; target < 185/110 mmHg before and during alteplase infusion
Explanation
Per AHA/ASA stroke guidelines, BP must be lowered to < 185/110 mmHg before IV alteplase administration and maintained below that threshold during and for 24 hours after thrombolysis. This reduces haemorrhagic transformation risk. Aggressive reduction below 140/90 is not recommended peri-thrombolysis as it may reduce penumbral perfusion. IV labetalol or nicardipine are the agents of choice for this purpose.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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