2022 AHA /ASA ICH Guidelines Emphasize Smooth, Sustained BP Control in ICH
American Heart Association/American Stroke Association Class 2 recommendations highlight the importance of limiting BP variability.1
“When implementing acute blood pressure lowering after mild to moderate ICH, treatment regimens that limit blood pressure variability and achieve smooth, sustained blood pressure control appear to reduce hematoma expansion and yield better functional outcome.”1
WHAT DO ICH GUIDELINES SAY ABOUT BP CONTROL?Recommendations for acute BP lowering for mild to moderate spontaneous ICH (COR, LOE)1: |
CONSIDER CLEVIPREX® (clevidipine) FOR TITRATABLE BP CONTROL*Features of CLEVIPREX, demonstrated in ACCELERATE, an open-label, single arm, pilot study of efficacy/safety in ICH patients with hypertension (N=35)2†: |
Careful titration to ensure continuous smooth and sustained control of BP, avoiding peaks and large variability in SBP, can be beneficial for improving functional outcomes. (2a, B-NR)1 | Continuous and sustained control In ACCELERATE, SBP decreased from baseline by a mean of 10.8 mm Hg (5.9%) at 3 minutes and 38.8 mm Hg (20%) by 30 minutes and remained within target SBP range (140 to 160 mm Hg)2 |
Initiating treatment within 2 hours of ICH onset and reaching target within 1 hour can be beneficial to reduce the risk of HE and improve functional outcome. (2a, C-LD)1 | Rapid onset of action† • Begins to reduce SBP within 2 to 4 minutes of initiation dose3 • In ACCELERATE, median time to target range SBP was 5.5 minutes after treatment initiation2 |
In patients presenting with SBP between 150 and 220 mm Hg, acute lowering of SBP to a target of 140 mm Hg, with the goal of maintaining in the range of 130 to 150 mm Hg, is safe and may be reasonable for improving functional outcomes. (2b, B-R)1 | Targeted and predictable control • An approximate 1 to 2 mg/h increase will generally produce an additional 2 to 4 mm Hg decrease in SBP3 • In ACCELERATE, all patients (n=33) achieved target SBP within 30 minutes2 |
In patients presenting with SBP >150 mm Hg, acute lowering to <130 mm Hg may be harmful. (3: Harm, B-R)1 | Fast off-set • ~1-minute half-life, with full SBP recovery achieved for most patients 5 to 15 minutes after the infusion is discontinued3 • In ACCELERATE, dose reduction or drug discontinuation resolved mild/moderate hypotension (reported in 3 patients)2 |
There is a lack of evidence to guide the choice of BP-lowering agents during the hyperacute phase after ICH, including bolus versus drip management.1 |
*CLEVIPREX data were not included within the AHA/ASA ICH Guidelines. †CLEVIPREX has not been adequately studied to impact HE or functional outcomes in patients with ICH. |
Review ICH Guidelines | Review Accelerate Clinical Data |

AHA/ASA ICH Guidelines Summary
Take a closer look at how CLEVIPREX supports care priorities outlined in the 2022 AHA/ASA ICH Guidelines.

Time is Brain in ICH, too!
Review CODE ICH: An Important Opportunity to Impact Functional Outcomes
AHA/ASA=American Heart Association/American Stroke Association; BP=blood pressure; B-NR = level B, nonrandomized; B-R = level B, randomized; COR=class of recommendation; HE=hematoma expansion; C-LD = level C, limited data; ICH=intracerebral hemorrhage; SBP=systolic blood pressure.
References: 1. Greenberg SM, Ziai WC, Cordonnier C, et al. 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: A guideline from the American Heart Association/American Stroke Association. Stroke. 2022;53:e282–e361. DOI: 10.1161/STR.0000000000000407. 2. Graffagnino C, Bergese S, Love J, et al. Clevidipine rapidly and safely reduces blood pressure in acute intracerebral hemorrhage: The ACCELERATE trial. Cerebrovasc Dis. 2013;36(3):173-180. 3. CLEVIPREX® (clevidipine) Prescribing Information, 2021.
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