Blood Pressure Management in Acute Bleed

• If presenting with SBP between 150 and 220 mmHg, acute lowering of SBP to target of 140 mmHg (maintenance 130 to 150 mmHg) is safe

  • Initiate treatment with 2 hours of ICH onset and reach target within 1 hour of treatment initiation

  • Labetalol

    • 5-10 mg IV over 1-2 minutes

    • Dose may be repeated or doubled q10 minutes to max of 150 mg

  • Hydralazine 5-10 mg IV if HR too low for labetalol

  • Antihypertensive Drips (Nicardipine)

    • If patient is requiring PRN labetalol or hydralazine, anticipate the need for antihypertensive drip and order immediately

    • Nicardipine

      • Start 5 mg/hr, increase by 2.5 mg q5-15 minutes until max 15 mg/hr (per package insert, may override up to 20 mg/hr if necessary)

• If presenting with SBP > 150 mmHg, acute lowering to target < 130 mmHg is potentially harmful