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Proposed Institutional Guidelines for Managing Hypertension in Patients with Stroke Based on AHA/ASA GuidelinesIschemic Stroke, No Reperfusion TherapyBP LevelSBP > 220 mm Hg or DBP>120 mm HgTarget BPReduce BP by 15% - 25% within 24 hoursRecommended IV antihypertensive optionsNicardipine 5 mg/hr; titrate up by 2.5 mg/hr every 5-15 minutes to a maximum of 15 mg/hr until desired BP achieved.Labetolol, 10 mg followed by continuous infusion at 2-8 mg/minConsider nitroprusside if resistant.? Start at 0.3 mcg/kg/min and titrate slowly.Ischemic Stroke with Reperfusion TherapyBP LevelSBP > 185 mmHg or DBP > 110 mmHgTarget BPSBP > 185 mmHg or DBP > 110 mmHgRecommended IV antihypertensive optionsNicardipine 5 mg/hr; titrate up by 2.5 mg/hr every 5-15 minutes to a maximum of 15 mg/hr until desired BP achieved.Labetolol, 10 mg followed by continuous infusion at 2-8 mg/minOther agents (hydralazine, enalapril) when appropriateHemorrhage Stroke with ICHBP LevelSBP > 200 mmHg or MAP > 150 mmHg: Aggressive reduction with continuous IV therapyIf increased ICP suspected and SBP > 180 mm Hg or MAP > 130 mmHg:? Intermittent or continuous IV therapy while maintaining CPP at ≥ 60 mmHgSBP > 180 mmHg or MAP > 130 mmHg and no evidence of elevated ICP: Consider intermittent or continuous IV therapy to achieve moderate BP reductionTarget BPBP < 160/90 mm Hg or MAP < 110 mmHgRecommended IV antihypertensive optionsNicardipine or LabetololSAHBP LevelUnclearOne prehospital study suggested SBP > 160 mmHgTarget BPUnclearRecommended IV antihypertensive optionsAdminister short acting continuous intravenous infusions of Nicardipine, Labetolol, Esmolol ................
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