A 72-year-old woman presents 3.5 hours after sudden onset left-sided hemiplegia and dysphasia. NIHSS is 12. Non-contrast CT brain shows no haemorrhage and no early infarct signs. BP is 170/95 mmHg. She has no contraindications to thrombolysis. What is the CORRECT BP target before administering IV alteplase?
- A Reduce BP to < 185/110 mmHg before and maintain ≤ 180/105 mmHg during and for 24 hours after thrombolysis ✓
- B Reduce BP to < 140/90 mmHg before alteplase
- C No blood pressure treatment is needed before thrombolysis
- D Reduce BP to < 160/100 mmHg before alteplase
Correct answer: A. Reduce BP to < 185/110 mmHg before and maintain ≤ 180/105 mmHg during and for 24 hours after thrombolysis
Explanation
Current AHA/ASA stroke guidelines require BP to be controlled to <185/110 mmHg before initiating IV alteplase and maintained ≤180/105 mmHg for at least 24 hours after thrombolysis to reduce the risk of haemorrhagic transformation. Aggressive lowering to <140/90 mmHg acutely in ischaemic stroke is not recommended as it may worsen penumbral ischaemia. This patient's BP of 170/95 already meets the threshold, so thrombolysis can proceed.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.