American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the maximum allowable blood pressure before administering tPA for ischemic stroke?

1. 190/100 mm Hg

2. 185/110 mm Hg

3. 180/120 mm Hg

4. 200/90 mm Hg

The correct answer is: 185/110 mm Hg

The maximum allowable blood pressure before administering tissue plasminogen activator (tPA) for ischemic stroke is 185/110 mm Hg. This threshold is crucial because achieving adequate blood pressure control is necessary to minimize the risk of hemorrhagic transformation after the administration of tPA, which is a potent thrombolytic therapy. When a patient presents with an acute ischemic stroke, careful assessment of their blood pressure is required. The goal is to ensure that the blood pressure is not too high, as elevated blood pressure can increase the likelihood of complications such as intracranial hemorrhage. The American Heart Association/American Stroke Association guidelines specifically recommend that tPA can be administered safely if systolic blood pressure is less than or equal to 185 mm Hg and diastolic blood pressure is less than or equal to 110 mm Hg. Other options provided exceed this recommended threshold, meaning they would not meet the guidelines for safe tPA administration in the context of an ischemic stroke. Therefore, maintaining the blood pressure at or below the recommended limit is a critical component of the protocol for treating acute ischemic stroke with tPA.