Acute Intracerebral Hemorrhage Recommendations for Management of Hypertension in Patients With Acute Intracerebral Hemorrhage (ICH) References that support recommendations are summarized in Online Data Supplement 41. COR LOE Recommendations IIa C-EO 1. In adults with ICH who present with SBP greater than 220 mm Hg, it is reasonable to use continuous intravenous drug infusion (Table 19) and close BP monitoring to lower SBP. III: Harm A 2. Immediate lowering of SBP (Table 19) to less than 140 mm Hg in adults with spontaneous ICH who present within 6 hours of the acute event and have an SBP between 150 mm Hg and 220 mm Hg is not of benefit to reduce death or severe disability and can be Synopsis Spontaneous, nontraumatic ICH is a significant global cause of morbidity and mortality.S9.4.1-3 Elevated BP is highly prevalent in the setting of acute ICH and is linked to greater hematoma expansion, neurological worsening, and death and dependency after ICH. Figure 7 is an algorithm on management of hypertension in patients with acute ICH. Recommendation-Specific Supportive Text 1. Information about the safety and effectiveness of early intensive BP-lowering treatment is least well established for patients with markedly elevated BP (sustained SBP >220 mm Hg) on presentation, patients with large and severe ICH, or patients requiring surgical decompres- sion. However, given the consistent nature of the data linking high BP with poor clinical outcomesS9.4.1-4 S9.4.1-6 and some suggestive data for treatment in patients with modestly high initial SBP levels,S9.4.1-1,S9.4.1-7 early lowering of SBP in ICH patients with markedly high SBP levels (>220 mm Hg) might be sensible. A second- ary endpoint in 1 RCT and an overview of data from 4 RCTs indicate that intensive BP reduction, versus BP- lowering guideline treatment, is associated with greater functional recovery at 3 months.S9.4.1-1,S9.4.1-7 2. 