Options to treat arterial hypertension in patients with AIS who are candidates for immediate reperfusion therapy are given in Table 5. Some observational studies suggest that the risk of hemorrhage after administration of alteplase is greater in patients with higher BPs125 131 and in patients with more BP variability.132 The exact BP at which the risk of hemorrhage after IV alteplase increases is unknown. It is thus reasonable to target the BPs used in the RCTs of IV alteplase. See Tables XX and XXX in online Data Supplement 1. In patients for whom mechanical thrombectomy is planned and who have not received IV fibrinolytic therapy, it is reasonable to maintain BP 185/110 mmHg before the procedure. IIa B-NR Recommendation revised from 2013 AIS Guidelines. Of the 6 RCTs that each independently demonstrated clinical benefit of mechanical thrombectomy with stent retrievers when performed <6 hours from stroke onset, 5 (REVASCAT, SWIFT PRIME, EXTEND-IA, THRACE, and MR CLEAN)106 110 had eligibility exclusions for BP >185/110 mmHg. The sixth, ESCAPE,105 had no BP eligibility exclusion. DAWN also used an exclusion for BP >185/110 mmHg.51 RCT data for optimal BP management approaches in this setting are not available. Because the vast majority of patients enrolled in these RCTs had preprocedural BP managed below 185/110 mmHg, it is reasonable to use this level as a guideline until additional data become available. See Table XVII in online Data Supplement 1. The usefulness of drug-induced hypertension in patients with AIS is not well established. IIb B-R Recommendation and COR unchanged from 2013 AIS Guidelines. LOE amended to conform with ACC/AHA 2015 Recommendation Classification System. 3.1. Airway, Breathing, and Oxygenation (Continued) COR LOE New, Revised, or Unchanged Powers et al 2019 Guidelines for Management of AIS e361 3.3. 