ABC | Volume 114, Nº4, April 2020

Statement Luso-Brazilian Position Statement on Hypertensive Emergencies – 2020 Arq Bras Cardiol. 2020; 114(4)736-751 Figure 2 – Fundoscopy showing normal papillae, diffuse arteriolar narrowing, areas with superficial hemorrhage, and microaneurysms (grade III hypertensive retinopathy according to the Keith-Wagener classification). Figure 3 – Anatomopathological lesions typical of accelerated-malignant hypertension. Fibrinoid necrosis of an afferent arteriole (arrow) (A). Obliterating endarteritis ("onion skin" lesions) (B). Fibrinoid necrosis of an afferent arteriole Obliterating endarteritis "Onion skin" lesions) 7.1. Ischemic Stroke In ischemic stroke, careful BP reductions of 10 to 15% are recommended at the end of the first hour after initiation of therapy and only if SBP is > 220 mmHg or DBP is > 120 mmHg. 40 If SBP is > 180 to 230 mmHg or DBP is > 105 to 120 mmHg and the patient is not undergoing thrombolysis, the following therapy is recommended: intravenous labetalol 10 mg followed by continuous infusion at a dose of 2 to 8 mg/min; or nicardipine at the cited doses until the desired effect is obtained. If uncontrolled BP or DBP > 140 mmHg persists, intravenous sodium nitroprusside should be considered. 40 In the case of individuals with elevated BP and indication for thrombolytic therapy with alteplase, BP should be carefully reduced until SBP < 185 mmHg and DBP < 110 mmHg before administration of the thrombolytic. If BP remains above 185/110 mmHg, thrombolytic therapy should not be administered. 40 Labetalol is the first medication of choice, and nicardipine is the alternative therapy. A dose of intravenous labetalol of 10 to 20 mg is recommended for 1 to 2 minutes (may be repeated once). Nicardipine is recommended at the dose of 5 mg/h and administered intravenously, with dose titration of 2.5 mg/h every 5 to 15 minutes (maximum dose of 15 mg/h). During or after 743