Effects of a Pharmacist–Physician Collaborative Protocol for Acute Blood Pressure Management of Patients with Intracerebral Hemorrhage

Background/Objectives: In the acute and subacute phases of spontaneous intracerebral hemorrhage (ICH), appropriate systolic blood pressure (SBP) control is important to limit hematoma expansion. However, optimal blood pressure management should be individualized according to hemorrhage severity and the patient’s clinical condition. In clinical practice, dose control of antihypertensive agents and timing of transition from intravenous to oral agents have been left at the discretion of attending physicians, resulting in fluctuations in blood pressure and delayed withdrawal from intravenous agents. In this study, pharmacists and physicians collaborated to develop a standardized blood pressure management protocol for acute ICH to achieve the target SBP and facilitate early withdrawal from intravenous antihypertensive agents. Methods: In March 2022, we developed a protocol comprising strict blood pressure control during the first 24 h, standardized titration of intravenous antihypertensive agents, and predefined oral antihypertensive therapy. We evaluated the effects of the protocol on achievement of SBP < 140 mmHg over 7 days, timing of withdrawal from intravenous antihypertensive agents, and unfavorable consequences associated with prolonged intravenous infusion, including delirium. Results: Achievement of SBP < 140 mmHg significantly increased from 20% (9/46) to 54% (27/50) after protocol implementation (p = 0.001), with a significant adjusted association (adjusted odds ratio, 5.51; 95% CI, 2.09–14.51). Median time to nicardipine discontinuation decreased from 72.5 to 37.5 h (log-rank p = 0.018). Delirium incidence was unchanged, whereas its median duration among affected patients decreased from 2 to 1 day. Conclusions: Protocol implementation was associated with improved target SBP achievement and earlier intravenous nicardipine discontinuation. Clinical benefits and safety require further investigation.