title: Clevidipine rapidly and safely reduces blood pressure in acute intracerebral hemorrhage: the ACCELERATE trial.
abstract: BACKGROUND
  Intracerebral hemorrhage (ICH) causes 10-15% of primary strokes, with mortality related to hematoma volume. Blood pressure (BP) reduction may attenuate hematoma expansion. ACCELERATE (the Evaluation of Patients with Acute Hypertension and Intracerebral Hemorrhage with Intravenous Clevidipine Treatment) is a pilot study representing the first evaluation of safety and efficacy of intravenous clevidipine for the rapid treatment of hypertension in ICH patients.
  
  
  METHODS
  ICH patients with a systolic BP (SBP) >160 mm Hg who present within 6 h (n = 27) or 12 h (n = 10) of symptoms were prospectively enrolled, treated with open-label clevidipine until SBP ≤160 mm Hg was achieved and then titrated to keep target SBP between 140-160 mm Hg.
  
  
  RESULTS
  A total of 35 patients with baseline median Glasgow Coma Scale score of 12, median NIH Stroke Scale score of 14, mean SBP of 186 mm Hg and a mean time from onset of symptoms of 5.5 h received clevidipine. Median time to achieve SBP target range was 5.5 min. All patients achieved target SBP within 30 min; 96.9% achieved target SBP with clevidipine monotherapy. CT scans showed minimal hematoma volume change for the overall population (median change 0.01 ml, -2.9%). Mild/moderate hypotension was reported in 3 patients and resolved with dose reduction or drug discontinuation.
  
  
  CONCLUSIONS
  Clevidipine monotherapy was effective and safe for rapid BP reduction in this cohort of critically ill ICH patients. Overall, patients showed minimal hematoma expansion with BP reduction, suggesting that rapid BP control with clevidipine may have a beneficial impact on hematoma expansion and warrants further investigation.
authors.affiliation: Duke University Medical Center, Durham, N.C., USA.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Graffagnino
authors.forename: Sergio
authors.initials: S
authors.lastname: Bergese
authors.forename: James
authors.initials: J
authors.lastname: Love
authors.forename: Dietmar
authors.initials: D
authors.lastname: Schneider
authors.forename: Christos
authors.initials: C
authors.lastname: Lazaridis
authors.forename: Marc
authors.initials: M
authors.lastname: LaPointe
authors.forename: Kiwon
authors.initials: K
authors.lastname: Lee
authors.forename: Gwendolyn
authors.initials: G
authors.lastname: Lynch
authors.forename: Ming-yi
authors.initials: MY
authors.lastname: Hu
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Williams
mesh_terms: D000208:Acute Disease; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000188:drug therapy*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D011725:Pyridines; C118563:clevidipine