For patients with acute ischemic stroke and BP >185/110, at what point do you consider persistently elevated BP too refractory to safely give thrombolysis?

Elevated BP is only very rarely truly refractory. I have never encountered a situation where I could not lower the BP in a timely fashion. So, directly, if the patient is appropriate for intravenous thrombolysis, I generally treat BP (give IV medications) in one IV and give thrombolysis in the other...

I agree with Dr. @Dr. First Last. There is nothing "magic" about the 185/100 level for treating with thrombolytics. I would make these points.

1. In general, use your common sense. If the BP is very high and uncontrolled, don't treat until you have a good IV, have started the nicardipine drip, and see...

I use 180/105 as my goal since this is the post-administration BP guideline. If they don't respond to one shot of labetalol 20mg IV, I go straight to a drip like Cardene with cleviprex or esmolol reserved as backups if Cardene doesn't work or isn't available. I make sure they're below 180/105 for at...

I would not administer thrombolytics until the BP is consistently below 185 mm Hg systolic and 110 mm Hg diastolic.