Table 1 Antihypertensive drug options for treating hypertension in acute ischemic stroke (> 220/110 mmHg in non-tPA candidates and > 185/105 mmHg in t-PA candidates; caveats for concurrent select hypertensive emergencies)
From: Management of acute ischemic stroke in the emergency department: optimizing the brain
Drug | Dose | Onset of action | Elimination half life | Duration of action | Contra-indications | Caution |
|---|---|---|---|---|---|---|
Labetalol | 10–20 mg IV over 1–2 min, may repeat 1 time | 2–5 min | 5.5 h | 4 h | Bradycardia; 2nd or third-degree heart block, severe asthma | |
Clevidipine | 1–2 mg/h IV, titrate by doubling the dose every 2–5 min until desired BP reached; maximum 21 mg/h | 2–4 min | 1 min | 5–15 min | Lipid emulsification can result in hypertriglyceridemia | |
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 | 5–10 min | 40–60 min | 15–90 min | Severe aortic stenosis | Cumulative doses can result in cyanide toxicity |
Enalaprilat | 1.25 mg/dose given over 5 min every 6 h | < 15 min | 35 h | 6 h | history of angioedema related to an ACE inhibitor; bilateral renal artery stenosis | Not easily titratable, long half life |