Blood Pressure Control With Clevidipine Is Associated With Hematoma Volume Reduction in Acute Hypertensive Intracerebral Hemorrhage: A Single‐Center Prospective Cohort Study

OBJECTIVES: Intracerebral hemorrhage (ICH) is associated with adverse functional outcomes and elevated mortality, driven by hematoma size and expansion. Timely blood pressure (BP) management may help mitigate hematoma growth. We aimed to assess the effects of clevidipine, an intravenously administered calcium-channel blocker, on hematoma volume and functional outcomes compared with standard antihypertensive therapy in hypertensive ICH patients. METHODS: We performed a prospective cohort study with a historical control group assessing serial hematoma volume measurements and clinical outcomes in acute hypertensive ICH patients treated with intravenous clevidipine (2023-2025) compared with standard antihypertensive therapy using labetalol, clonidine and/or diuretics (2020-2022; prior to clevidipine availability). RESULTS: Sixty-four patients (cases:25; controls:39) were included. There was no difference in demographic characteristics and admission National Institutes of Health Stroke Scale (NIHSS) scores between cases and controls. Clevidipine administration resulted in effective BP control (< 140/90 mmHg) within 3.5 ± 3.2 h from treatment onset, with no hematoma expansion (0.0 vs. 7.7% in controls; p = 0.172) and significant ICH volume reduction on 24-h follow-up brain-CT (14.7% vs. 4.5% in controls; p = 0.023). A trend toward greater improvement in NIHSS scores during hospitalization and numerically lower 3-month mortality rates were observed in clevidipine group. No serious adverse events were reported in the clevidipine-treated patients. In multivariable linear regression models adjusting for potential confounders, clevidipine-use was independently associated with greater ICH-volume reduction (β = -0.16, 95% CI: -0.30, -0.02, p = 0.024). CONCLUSIONS: The present study highlights that clevidipine represents a safe and effective option in terms of acute BP management among patients with hypertensive ICH and may limit hematoma expansion.