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Acute Management of Hypertension Following Intracerebral Hemorrhage

Haller, J. Tyler, PharmD; Wiss, Adam L., PharmD; May, Casey C., PharmD, BCCCP; Jones, G. Morgan, PharmD, BCPS, BCCCP; Smetana, Keaton S., PharmD, BCCCP

doi: 10.1097/CNQ.0000000000000247
Original Articles

Intracerebral hemorrhage (ICH) is responsible for approximately 15% of strokes annually in the United States, with nearly 1 in 3 of these patients dying without ever leaving the hospital. Because this disproportionate mortality risk has been stagnant for nearly 3 decades, a main area of research has been focused on the optimal strategies to reduce mortality and improve functional outcomes. The acute hypertensive response following ICH has been shown to facilitate ICH expansion and is a strong predictor of mortality. Rapidly reducing blood pressure was once thought to induce cerebral ischemia, though has been found to be safe in certain patient populations. Clinicians must work quickly to determine whether specific patient populations may benefit from acute lowering of systolic blood pressure (SBP) following ICH. This review provides nurses with a summary of the available literature on blood pressure control following ICH. It focuses on intravenous and oral antihypertensive medications available in the United States that may be utilized to acutely lower SBP, as well as medications outside of the antihypertensive class used during the acute setting that may reduce SBP.

Department of Pharmacy, Methodist University Hospital, Memphis, Tennessee (Drs Haller and Jones); Department of Pharmacy, The Ohio State University Wexner Medical Center; Columbus (Drs Wiss, May, and Smetana); and Department of Clinical Pharmacy, Neurology and Neurosurgery, University of Tennessee Health Sciences Center, Memphis (Dr Jones).

Correspondence: Keaton S. Smetana, PharmD, BCCCP, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, Doan Hall Room 368, Columbus, OH 43210 (

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

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