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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Effects of a Pharmacist–Physician Collaborative Protocol for Acute Blood Pressure Management of Patients with Intracerebral Hemorrhage

  • Takaya Sagawa1,2
  • Hitoshi Fukuda3
  • Tomoaki Ishida4
  • Ryota Sakoda1
  • Shumpei Morisawa1
  • Keita Akagaki1,2
  • Takumi Maruyama1
  • Kei Kawada5,6
  • Ken Shinno3
  • Takako Kawamura3
  • Yu Kawanishi3
  • Tetsuya Ueba3
2 more authors
  • Yukihiro Hamada1,2
  • Kohei Jobu1,2
6 affiliations
  1. 1Department of Pharmacy, Kochi Medical School Hospital, Kochi University, 185-1, Kohasu, Oko-cho, Nankoku-shi 7838505, Kochi, Japan
  2. 2Graduate School of Integrated Arts and Sciences, Kochi University, 185-1, Kohasu, Oko-cho, Nankoku-shi 7838505, Kochi, Japan
  3. 3Department of Neurosurgery, Kochi Medical School, Kochi University, 185-1, Kohasu, Oko-cho, Nankoku-shi 7838505, Kochi, Japan
  4. 4Department of Clinical Pharmacy, Graduate School of Pharmaceutical Sciences, Nagoya City University, 3-1 Tanabe-dori, Mizuho-ku, Nagoya-shi 4678603, Aichi, Japan
  5. 5Department of Clinical Pharmacology and Therapeutics, Graduate School of Biomedical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima 7708503, Tokushima, Japan
  6. 6Department of Pharmacy, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima 7708503, Tokushima, Japan
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Abstract

Background/Objectives: In the acute and subacute phases of spontaneous intracerebral hemorrhage (ICH), appropriate systolic blood pressure (SBP) control is important to limit hematoma expansion. However, optimal blood pressure management should be individualized according to hemorrhage severity and the patient’s clinical condition. In clinical practice, dose control of antihypertensive agents and timing of transition from intravenous to oral agents have been left at the discretion of attending physicians, resulting in fluctuations in blood pressure and delayed withdrawal from intravenous agents. In this study, pharmacists and physicians collaborated to develop a standardized blood pressure management protocol for acute ICH to achieve the target SBP and facilitate early withdrawal from intravenous antihypertensive agents. Methods: In March 2022, we developed a protocol comprising strict blood pressure control during the first 24 h, standardized titration of intravenous antihypertensive agents, and predefined oral antihypertensive therapy. We evaluated the effects of the protocol on achievement of SBP < 140 mmHg over 7 days, timing of withdrawal from intravenous antihypertensive agents, and unfavorable consequences associated with prolonged intravenous infusion, including delirium. Results: Achievement of SBP < 140 mmHg significantly increased from 20% (9/46) to 54% (27/50) after protocol implementation (p = 0.001), with a significant adjusted association (adjusted odds ratio, 5.51; 95% CI, 2.09–14.51). Median time to nicardipine discontinuation decreased from 72.5 to 37.5 h (log-rank p = 0.018). Delirium incidence was unchanged, whereas its median duration among affected patients decreased from 2 to 1 day. Conclusions: Protocol implementation was associated with improved target SBP achievement and earlier intravenous nicardipine discontinuation. Clinical benefits and safety require further investigation.

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Cite

BibTeXRIS
BibTeX
@article{sagawa2026effects,
  title = {{Effects of a Pharmacist–Physician Collaborative Protocol for Acute Blood Pressure Management of Patients with Intracerebral Hemorrhage}},
  author = {Takaya Sagawa and Hitoshi Fukuda and Tomoaki Ishida and Ryota Sakoda and Shumpei Morisawa and Keita Akagaki and Takumi Maruyama and Kei Kawada and Ken Shinno and Takako Kawamura and Yu Kawanishi and Tetsuya Ueba and Yukihiro Hamada and Kohei Jobu},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = nov,
  doi = {10.3390/jcm15218733},
  url = {https://www.mdpi.com/2077-0383/15/21/8733},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Effects of a Pharmacist–Physician Collaborative Protocol for Acute Blood Pressure Management of Patients with Intracerebral Hemorrhage
AU  - Takaya Sagawa
AU  - Hitoshi Fukuda
AU  - Tomoaki Ishida
AU  - Ryota Sakoda
AU  - Shumpei Morisawa
AU  - Keita Akagaki
AU  - Takumi Maruyama
AU  - Kei Kawada
AU  - Ken Shinno
AU  - Takako Kawamura
AU  - Yu Kawanishi
AU  - Tetsuya Ueba
AU  - Yukihiro Hamada
AU  - Kohei Jobu
PY  - 2026
DA  - 2026/11/09
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218733
UR  - https://www.mdpi.com/2077-0383/15/21/8733
AB  - Background/Objectives: In the acute and subacute phases of spontaneous intracerebral hemorrhage (ICH), appropriate systolic blood pressure (SBP) control is important to limit hematoma expansion. However, optimal blood pressure management should be individualized according to hemorrhage severity and the patient’s clinical condition. In clinical practice, dose control of antihypertensive agents and timing of transition from intravenous to oral agents have been left at the discretion of attending physicians, resulting in fluctuations in blood pressure and delayed withdrawal from intravenous agents. In this study, pharmacists and physicians collaborated to develop a standardized blood pressure management protocol for acute ICH to achieve the target SBP and facilitate early withdrawal from intravenous antihypertensive agents. Methods: In March 2022, we developed a protocol comprising strict blood pressure control during the first 24 h, standardized titration of intravenous antihypertensive agents, and predefined oral antihypertensive therapy. We evaluated the effects of the protocol on achievement of SBP < 140 mmHg over 7 days, timing of withdrawal from intravenous antihypertensive agents, and unfavorable consequences associated with prolonged intravenous infusion, including delirium. Results: Achievement of SBP < 140 mmHg significantly increased from 20% (9/46) to 54% (27/50) after protocol implementation (p = 0.001), with a significant adjusted association (adjusted odds ratio, 5.51; 95% CI, 2.09–14.51). Median time to nicardipine discontinuation decreased from 72.5 to 37.5 h (log-rank p = 0.018). Delirium incidence was unchanged, whereas its median duration among affected patients decreased from 2 to 1 day. Conclusions: Protocol implementation was associated with improved target SBP achievement and earlier intravenous nicardipine discontinuation. Clinical benefits and safety require further investigation.
SN  - 2077-0383
ER  -