Table 2.

Acute BP treatment protocols

A. <140 mmHg Target Group
	Target SBP <140 mmHg within 30 min of randomization
Monitoring	● Record BP/HR qa5 min during active treatment; q15 min × 1 h, q30 min × 5 h and q1h × 18 h
Labetalol (IV)	● Labetalol test dose: 10 mg bolus over 1 min ● If SBP ≥140 mmHg and HR >55 BPM, repeat 10 mg bolus in 5 min. ● 10–20 mg IV push q5 min until SBP <140 mmHg or HR <55 BPM ● Maximum labetalol dose: 300 mg/24 h
And Enalapril (IV) (If available)	● Enalapril 1.25 mg bolus
And/or Hydralazine (IV)	If BP persistently >140 mmHg: ● Hydralazine test dose: 5 mg IV bolus over 1 min ● If SBP ≥140 mmHg, repeat 5 mg IV bolus in 5 min ● 10–20 mg IV bolus q5 min until SBP <140 mmHg ● Maximum hydralazine dose = 240 mg/24 h
Continuous IV Infusions (ICU admission)	If BP persistently >140 mmHg: ● Labetalol infusion 2–8 mg/min (maximum 300 mg/24 h) and/or hydralazine infusion 50–150 μg/min
Maintenance Therapy
Maintain SBP <140 mmHg × 24 h minimum
IV treatment prnb	If SBP >140 mmHg at any point: ● Labetalol (10–20 mg) / hydralazine (10–20 mg) boluses. Record BP/HR 5 and 15 min later ● Enalapril 1.25 mg q6 h if SBP >140 mmHg ● If SBP ≤135 mmHg or HR <55 BPM, hold maintenance dose
B. <180 mmHg Target Group
	Protocol to be used only if SBP ≥180 mmHg
Monitoring	● as listed above
Labetalol (IV)	● Labetalol test dose: 10 mg bolus over 1 min ● If SBP ≥180 mmHg and HR >55 BPM, repeat 10 mg bolus in 5 min. ● 10–20 mg IV push q5 min until SBP <180 mmHg or HR <55 BPM ● Maximum labetalol dose: 300 mg/24 h
Hydralazine (IV)	If BP persistently >180 mmHg: ● Hydralazine test dose: 5 mg IV bolus over 1 min ● If SBP ≥180 mmHg, repeat 5 mg IV bolus in 5 min ● 10–20 mg IV bolus q5 min until SBP <180 mmHg ● Maximum hydralazine dose = 240 mg/24 h
Maintenance Therapy
IV treatment prn	If SBP >180 mmHg at any point during 24 h: ● Labetalol (10–20 mg) / hydralazine (10–20 mg) boluses. Record BP/HR 5 and 15 min later

^aq = every, ^bprn = when necessary