Table 2 Acute BP treatment protocols
From: The intracerebral hemorrhage acutely decreasing arterial pressure trial II (ICH ADAPT II) protocol
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 |