Table 6.

BIHS position: Management of blood pressure (BP) in acute intracerebral haemorrhage (ICH).

Hypertensive emergency state	Intracerebral haemorrhage
Speed of BP reduction and BP targets	1. Balance the risks of rapid and excessive BP reduction against the risk of ICH extension.
	2. The BP target and pace of reduction to be personalised based on background history, and ongoing response rather than a standard prespecified target.
	3. Appropriate targets are generally in the range of SBP 140-180 or DBP 90–110 mmHg.
	4. If BP is severely elevated (>220/120 mmHg), consider a smooth reduction in MAP no more than 20–25% over several hours (SBP should be kept ≥140 mmHg, preferably around 140–160 mmHg).
Medications	Drug of choice: Initially IV labetalol (managed in a high dependency unit) unless contraindicated, monitoring with neuro-observations and renal function. IV nicardipine may be suitable.