رجل عمره ٦٩ سنة عنده سكتة إقفارية بدأت قبل ساعتين، والأشعة لا تظهر نزيفاً، ولا يأخذ مميعات، وهو مرشح لمذيب الجلطة الوريدي. ضغطه ١٩٦/١١٢ في قراءتين. ما المتوقع قبل إعطاء المذيب؟

A 69-year-old man has an ischaemic stroke that began 2 hours ago; CT shows no bleed, he takes no anticoagulants and is a thrombolysis candidate. BP is 196/112 on two readings. What is expected before giving the thrombolytic?

1. Withhold the thrombolytic permanently because BP is high
2. Give the thrombolytic now because time matters more than BP
3. Lower BP to below 120/80
4. Lower BP to below 185/110

Answer: D) Lower BP to below 185/110. BP must be below 185/110 before thrombolysis and kept below 180/105 afterwards to limit bleeding risk, using IV agents such as labetalol or nicardipine.