American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be the target blood pressure to maintain after administering tPA for an acute ischemic stroke?

1. 160/90 mm Hg

2. 180/105 mm Hg

3. 120/80 mm Hg

4. 150/100 mm Hg

The correct answer is: 180/105 mm Hg

The recommended target blood pressure after administering tissue plasminogen activator (tPA) for an acute ischemic stroke is 180/105 mm Hg. This level is established based on guidelines that aim to strike a balance between maintaining adequate cerebral perfusion and minimizing the risk of hemorrhagic transformation following thrombolysis. High blood pressure can help facilitate cerebral perfusion to the affected area of the brain, especially in the immediate aftermath of the ischemic event. However, exceeding this threshold can increase the risk of complications. It is crucial to monitor blood pressure closely during the first 24 hours post-tPA administration, and if it rises above this threshold, appropriate antihypertensive measures should be taken to reduce the risk of such complications while ensuring that perfusion to the brain is adequately maintained. The other options suggest lower thresholds that may not adequately address the need for cerebral perfusion pressure following tPA administration, which is why they are not the accepted standard in this context.