A large majority of intracerebral hemorrhages, especially in younger patients, are due to hypertensive emergency. Often, these patients will get started on a titratable continuous IV drip medication like Nicardipine in the emergency room. However, there was a recent paper in Neurocritical Care journal that suggests that starting oral antihypertensives in conjunction during this very acute stage can lower morbidity, costs, and hospital/ICU stays. The rebuttal is of course that blood pressures on oral antihypertensives are subject to peaks and troughs with medication administration until steady state is reached. During this time, overshooting the target and causing hypotension can cause significant ischemia to surrounding cellular tissue that may be amenable to rehab, and hence worsening long-term outcomes [though this has not yet been systematically analyzed]. What is your opinion on this?

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