Which medication can be given to lower blood pressure before administering tPA?

Labetalol is effective in lowering blood pressure before administering tPA (tissue Plasminogen Activator) because it is a combined alpha and beta-adrenergic blocker. This dual action allows for a more balanced reduction in blood pressure while minimizing the risk of reflex tachycardia, which can occur with other antihypertensive medications.

In the context of acute ischemic stroke, it is crucial to manage blood pressure carefully, as high blood pressure (typically over 185/110 mmHg) can increase the risk of intracerebral hemorrhage when administering tPA. Labetalol's ability to provide rapid blood pressure control makes it a preferred choice in this scenario, ensuring that the patient's blood pressure is adequately lowered while still maintaining cerebral perfusion.

In contrast, propranolol, while effective at reducing blood pressure, is primarily a beta-blocker and is not typically used in acute settings because it can lead to significant heart rate changes and is less appropriate for immediate blood pressure control in emergencies. Amlodipine, a calcium channel blocker, works more gradually and may not achieve the rapid control needed before tPA is given. Enalapril is an ACE inhibitor that also does not provide the immediate effect