Summary box: BP agents of choice in acute stroke
| Acute ischaemic stroke (AIS) | Avoid large falls (>20%) in BP. |
| Aim for gradual BP reduction (5–15%). | |
| Intracerebral haemorrhage (ICH) | Rapid lowering of BP to ≤140 mm Hg within 6 hours of onset. |
| Intravenous agents | Require continuous cardiac monitoring. |
| Labetalol | 10–20 mg bolus, over 1–2 min. Further boluses can be given every 10 min, titrated to BP effect (maximum dose 300 mg). |
| Alternative: labetalol infusion. | |
| Glyceryl trinitrate | 10–200 μg/min infusion titrated to BP effect. |
| Nicardipine | Avoid large BP falls in AIS. |
| 5 mg/hour infusion titrated to BP effect. | |
| Sodium nitroprusside | Avoid in ICH due to antiplatelet effects. |
| 0.5 μg/kg/min initial dose, infusion then titrated to BP effect. | |
| Oral agents | Swallowing assessment required, up to 50% of patients dysphagic. |
| Sublingual agents | Rapidly absorbed, can cause steep falls in BP (limited data). |
| Transdermal agents | Glyceryl trinitrate 5–10 mg/24-hour patch according to BP effect. |