Purpose: To evaluate the proportion of patients with spontaneous intracerebral hemorrhage (ICH) achieving institutional systolic blood pressure (SBP) targets within 60 minutes of head computed tomography (HCT).
Methods: This retrospective cohort study included adult patients with spontaneous ICH admitted to entities within the University of Pennsylvania Health System between January 1, 2025, and November 30, 2025. Patients were stratified by presenting SBP (<220 mmHg vs >220 mmHg), corresponding to institutional protocol targets. For patients presenting with SBP greater than 220 mmHg, the initial goal is to reduce SBP to less than 180 mmHg within the first hour. For patients presenting with SBP between 180–220 mmHg, the target range is 130–150 mmHg. The primary outcome was achievement of protocol-defined SBP target within 60 minutes of HCT confirmation. Secondary outcomes included antihypertensive medication regimen, time to target SBP, SBP variability during the first six hours after HCT , neurologic outcomes , incidence of hematoma expansion or ischemic stroke, mortality, and safety outcomes including hypotension and bradycardia.
Results: A total of 39 patients met inclusion criteria (SBP <220 mmHg: n=23; SBP >220 mmHg: n=16). Achievement of target SBP within 60 minutes occurred more frequently in patients presenting with SBP > 220 mmHg (39.1% vs 93.8%, p<0.01). Nicardipine was utilized in all patients and was initiated within 30 minutes of HCT confirmation in 69.6% and 75% of patients with SBP <220 mmHg and >220 mmHg, respectively. In-hospital mortality occurred in 8.7% of patients with SBP <220 mmHg and 6.3% with SBP >220 mmHg (p=1.00). The incidence of ischemic stroke was 8.7% versus 25.0%, respectively (p=0.21). Hypotension occurred in one patient (4.3%) in the SBP <220 mmHg group (p=1.00). No cases of bradycardia were observed.
Conclusion: Patients with SBP >220 mmHg were more likely to achieve protocol-defined SBP targets within 60 minutes compared with those <220 mmHg. Despite rapid blood pressure reduction, rates of hypotension and bradycardia were low. These findings suggest that early SBP control in patients with moderately elevated SBP may reflect differences in clinical attention and management intensity, highlighting a potential need for more optimized titration strategies.
PGY2 Critical Care, Penn Medicine, Penn Presbyterian Medical Center
Liz completed her PGY-1 at St. Luke’s University Health Network and is currently completing a PGY-2 in critical care at Penn Presbyterian Medical Center.
