The optimal blood pressure (BP) management in critically ill patients with neurological emergencies in the
intensive care unit poses several challenges. Both over and under correction of the blood pressure are associated with
increased morbidity and mortality in this population. Target blood pressures and therapeutic management are based on
guidelines including those from the American Stroke Association and the Joint National Committee guidelines. We
review these recommendations and the current concepts of blood pressure management in neurological emergencies. A
variety of therapeutic agents including nicardipine, labetalol, nitroprusside are used for blood pressure management in
patients with ischemic and hemorrhagic strokes. Currently, the role of inducing hypertension remains unclear.
Hypertensive crises include hypertensive urgencies where elevated blood pressures are seen without end organ damage
and can usually be managed by oral agents, and hypertensive emergencies where end organ damage is present and
requires immediate treatment with intravenous drugs.