BP must be lowered to < 185/110 mmHg prior to reperfusion therapy and maintained < 180/105 mmHg following reperfusion therapy

• Labetalol

  • 5-10 mg IV over 1-2 minutes

  • Dose may be repeated or doubled q10 minutes to max of 150 mg

• Hydralazine 5-10 mg IV if HR too low for labetalol

• Antihypertensive Drips (Nicardipine)

  • If patient is requiring PRN labetalol or hydralazine, anticipate the need for antihypertensive drip and order immediately

  • Nicardipine

    • Start 5 mg/hr, increase by 2.5 mg q5-15 minutes until max 15 mg/hr (per package insert, may override up to 20 mg/hr if necessary)

Permissive hypertension to < 220/120 mmHg

Continue permissive hypertension for 24-48 hours, then gradually reduce blood pressure to long-term target