Bedside Pharmacist Impact on Blood Pressure Management in Spontaneous Intracerebral Hemorrhage

Introduction: Spontaneous intracerebral hemorrhage (ICH) is often triggered by uncontrolled hypertension, with sustained elevations increasing the risk of hematoma expansion and poor outcomes. Timely and controlled blood pressure (BP) reduction is therefore critical. Limited research exists on how pharmacist involvement affects BP management in ICH patients. This study evaluates bedside pharmacist impact on achievement of BP targets outlined by the American Heart Association/American Stroke Association (AHA/ASA) and institutional guidelines.


Methods: This multicenter, retrospective cohort study included adult patients presenting to OhioHealth emergency departments (ED) with spontaneous ICH from January 1, 2017 to January 1, 2024. Patients were stratified based on presence of a bedside pharmacist. Inclusion criteria consisted of initial SBP >160 mmHg and first antihypertensive administration after ED presentation. Exclusion criteria included a Glasgow coma scale score < 5, transfer from mobile stroke unit/facility outside of OhioHealth, do not resuscitate status, traumatic hemorrhages, and inpatient hemorrhagic stroke alerts. The primary outcome of this study was achievement of BP target within 2 hours of ED arrival (AHA/ASA goal). Secondary outcomes included achievement of BP target within 1 hour of ED arrival, hematoma expansion, hospital/ICU length of stay, and in-hospital mortality.


Results: Of 305 total patients, 153 had bedside pharmacist involvement in their initial care. A BP target of 2 hours was achieved in 86.9% of patients with pharmacist involvement versus 23.7% without (p < 0.001). Similarly, 55.6% of patients in the pharmacist-involvement cohort met the 1 hour institutional target, compared to 7.9% in the no/non-pharmacist cohort (p < 0.001). Secondary outcomes showed increased incidence of hematoma expansion, in-hospital mortality, and hospital length of stay in the pharmacist group, suggesting involvement of potential confounding variables.


Conclusions: Bedside pharmacist involvement significantly improves time to achievement of BP targets in spontaneous ICH. These findings support the integration of clinical pharmacists in emergency care for ICH management, though further studies are warranted to evaluate their impact on secondary clinical outcomes.