What is the recommended action for patients with ischemic stroke who are not candidates for tPA?

For patients with ischemic stroke who are not candidates for tissue plasminogen activator (tPA), the recommended action is to monitor blood pressure unless signs of organ injury appear. This approach is based on the understanding that acute management of blood pressure in the context of ischemic stroke requires careful consideration of the risks and benefits.

In patients who have suffered an ischemic stroke, blood pressure is often elevated, but immediate aggressive lowering is not advisable unless there are compelling reasons such as acute heart failure or hypertensive emergencies. The goal is to maintain adequate cerebral perfusion. Therefore, simply monitoring without intervening is appropriate unless there are indications that the elevated blood pressure is causing or contributing to organ injury.

This monitoring strategy allows clinicians to observe the patient's response to the stroke and provides an opportunity to manage blood pressure effectively in an individualized manner. If the patient starts to show symptoms indicative of organ damage due to hypertension, then more aggressive management can be considered at that point.

The other choices suggest unnecessary interventions like immediate transfer to surgical intervention or preemptive lowering of blood pressure, which may not address the patient's immediate needs or could potentially exacerbate their condition.