Table 12.4-3. Treatment of hypertension in patients with recent ischemic stroke not receiving fibrinolytic treatment (examples; other medications possible)

Blood pressure


SBP <220 mm Hg and DBP <120 mm Hg

Do not use antihypertensive agents. Hold 50% of previously used beta-blockers, hold other antihypertensive medications. Consider antihypertensive treatment in patients with severe heart failure, aortic dissection, or symptoms of hypertensive encephalopathy (choice of agents: see table 12.4-2)

SBP >220 mm Hg or DBP of 120-140 mm Hg

Benefit of lowering is uncertain but suggested. Lowering BP by 15% within the first 24 h and use of medications (see table 12.4-2) is reasonable (IV labetalol, nicardipine, clevidipine, hydralazine, enalaprilat [0.625-1.25 mg every 6 h])

DBP >140 mm Hg

– ICU admission

– IV sodium nitroprusside 0.5 microg/kg/min

a Target BP reduction is 10%-15%. Continuous BP monitoring is necessary. Onset, duration of action, and adverse effects of the drugs: see table 3.9-2.

BP, blood pressure; DBP, diastolic blood pressure; ICU, intensive care unit; SBP, systolic blood pressure.