Options to Treat Arterial Hypertension in Patients With AIS Who Are Candidates for Emergency Reperfusion Therapy* COR IIb LOE C-EO Patient otherwise eligible for emergency reperfusion therapy except that BP is >185/110 mmHg: Labetalol 10 20 mg IV over 1 2 min, may repeat 1 time; or Nicardipine 5 mg/h IV, titrate up by 2.5 mg/h every 5 15 min, maximum 15 mg/h; when desired BP reached, adjust to maintain proper BP limits; or Clevidipine 1 2 mg/h IV, titrate by doubling the dose every 2 5 min until desired BP reached; maximum 21 mg/h Other agents (eg, hydralazine, enalaprilat) may also be considered If BP is not maintained 185/110 mmHg, do not administer alteplase Management of BP during and after alteplase or other emergency reperfusion therapy to maintain BP 180/105 mmHg: Monitor BP every 15 min for 2 h from the start of alteplase therapy, then every 30 min for 6 h, and then every hour for 16 h If systolic BP >180 230 mmHg or diastolic BP >105 120 mmHg: Labetalol 10 mg IV followed by continuous IV infusion 2 8 mg/min; or Nicardipine 5 mg/h IV, titrate up to desired effect by 2.5 mg/h every 5 15 min, maximum 15 mg/h; or Clevidipine 1 2 mg/h IV, titrate by doubling the dose every 2 5 min until desired BP reached; maximum 21 mg/h If BP not controlled or diastolic BP >140 mmHg, consider IV sodium nitroprusside AIS indicates acute ischemic stroke; BP, blood pressure; COR, class of recommendation; IV, intravenous; and LOE, Level of Evidence. *Different treatment options may be appropriate in patients who have comorbid conditions that may benefit from rapid reductions in BP such as acute coronary event, acute heart failure, aortic dissection, or preeclampsia/eclampsia. Data derived from Jauch et al.1 3.5. IV Alteplase 3.5.1. 