Table 4. Emergent Management of Arterial Hypertension for Persons Receiving Thrombolytic Drugs for Acute Ischemic Stroke: Method Used by the NINDS Study Group6
| Monitor arterial blood pressure during the first 24 hours after starting treatment. |
 Every 15 minutes for 2 hours after starting the infusion, then |
| Every 30 minutes for 6 hours, then |
| Every 60 minutes until 24 hours after starting treatment. |
| If systolic blood pressure is 180-230 mm Hg or if diastolic blood pressure is 105-120 mm Hg for two or more readings 5-10 minutes apart: |
| Give intravenous labetalol 10 mg over 1-2 minutes. The dose may be repeated or doubled every 10-20 minutes up to a total dose of 150 mg. |
| Monitor blood pressure every 15 minutes during labetalol treatment and observe for development of hypotension. |
| If systolic blood pressure is >230 mm Hg or if diastolic blood pressure is in the range of 121-140 mm Hg for two or more readings 5-10 minutes apart: |
| Give intravenous labetalol 10 mg over 1-2 minutes. The dose may be repeated or doubled every 10 minutes up to a total dose of 150 mg. |
| Monitor blood pressure every 15 minutes during labetalol treatment and observe for development of hypotension. |
| If no satisfactory response, infuse sodium nitroprusside (0.5-10 µg/kg per minute).* |
| Continue monitoring blood pressure. |
| If diastolic blood pressure is >140 mm Hg for two or more readings 5-10 minutes apart: |
| Infuse sodium nitroprusside (0.5-10 µg/kg per minute).* |
| Monitor blood pressure every 15 minutes during infusion of sodium nitroprusside and observe for development of hypotension. |
|
*Continuous arterial monitoring is advised if sodium nitroprusside is used. The risk of bleeding secondary to an arterial puncture should be weighed against the possibility of missing dramatic changes in pressure during infusion.
