American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients with acute ischemic stroke outside the tPA window, blood pressure should be treated if it exceeds what level?

1. 160/100 mm Hg

2. 180/110 mm Hg

3. 200/120 mm Hg

4. 220/120 mm Hg

The correct answer is: 220/120 mm Hg

In patients with acute ischemic stroke who are outside the therapeutic window for tissue plasminogen activator (tPA), blood pressure management is essential due to the potential impact of hypertension on recovery and the risk of hemorrhagic transformation. The American Heart Association/American Stroke Association guidelines recommend that blood pressure should be treated in this context if it exceeds 220/120 mm Hg. Elevated blood pressure in the setting of acute ischemic stroke can be a physiological response to maintain cerebral perfusion. However, excessively high levels can increase the risk of complications, including hemorrhagic transformation of the infarct. The threshold of 220/120 mm Hg is established as a point at which immediate reduction of blood pressure is warranted to mitigate these risks while taking into consideration the underlying ischemic process. This level reflects a balance between adequately controlling hypertension and avoiding unnecessary treatment in patients who may benefit from the elevated blood pressure for perfusion. Blood pressure management should be individualized while considering the overall context of the patient's condition. Monitoring and follow-up are crucial in adjusting treatment as the patient's clinical status evolves.