LOE amended to conform with ACC/AHA 2015 Recommendation Classification System. Table 5. 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. 