BACKGROUND/AIMS:
Hyperacute blood pressure (BP) management in intracerebral haemorrhage (ICH) is now endorsed in Australian guidelines, though achieving BP targets has remained a challenge. Urapidil, used in international ICH BP trials including INTERACT‑3 and INTERACT‑4, offers both bolus and infusion dosing. As part of a quality improvement initiative, we introduced urapidil as the primary antihypertensive for ICH and compared pre‑ and in‑hospital BP control with historical cohorts managed with hydralazine boluses and/or nicardipine infusion.
METHODS:
Data for patients with ICH presenting to Royal Melbourne Hospital (RMH) between January-December 2025 were prospectively collected. For the pre‑hospital/Mobile Stroke Unit comparison, patients with adequate BP data enrolled in STOP‑MSU were included. The SBP target was <140mmHg within 1 hour of presentation.
RESULTS:
There were 190 patients with ICH admitted to RMH in 2025, of whom 85 received hyperacute BP management (excluded if presented >24hours, transferred or initial SBP <150mmHg). With the introduction of urapidil in June 2025, door-to-SBP control improved from a median of 116minutes (IQR 78-182.5minutes) to 91minutes (IQR 46-154.5minutes).
On assessment of pre-hospital BP management on the MSU, the 24 patients managed with urapidil had improved BP at hospital arrival (median 180mmHg to 159mmHg) compared to the historical cohort (n=38; median 161mmHg to 168mmHg).
No significant safety events (hypotension/renal impairment) have thus far occurred with use of urapidil.
CONCLUSIONS:
BP control improved substantially using urapidil as the primary agent, although treatment times still remained above target. Our data supports the efficacy and safety of urapidil use in an Australian ICH population.