Introduction: Clevidipine, a rapidly-acting, vascular-selective, L-type dihydropyridine calcium channel blocker, lowers blood pressure (BP) by reducing systemic vascular resistance and has a pharmacokinetic half-life of approximately 1 minute.The ACCELERATE trial evaluated blood pressure (BP) reduction with Ⅳ clevidipine in patients with acute intracerebral hemorrhage (ICH).Methods: Patients presenting with symptoms of ICH within 12 hours and systolic BP (SBP) >160 mmHg were enrolled and treated with open-label Ⅳ clevidipine.Clevidipine was started at 2.0 mg/h and tit rated every 90 seconds until SBP <=160 mmHg was achieved, then titrated to keep SBP between 140 to 160 mmHg.Glasgow Coma Scale (GCS) score, NIH Stroke Scale (NIHSS) score, and hematoma volume were measured.Results: Thirty-five patients (27 men, mean age 64 years) were enrolled and received clevidipine.Prior to treatment, median GCS score =14, median NIHSS score =13, mean hematoma volume =29 mL, mean SBP =186 mmHg and mean diastolic BP =85 mmHg.Mean time to infusion from symptom onset was 5.5 hours.Mean on-drug infusion duration from initiation to end of treatment was 28 hours.For patients who met study criteria (n=33), median time to achieving target SBP (<=160 mmHg to >=140 mmHg) was 5.5 min (95 % CI 3,10).All patients achieved SBP <=160 mmHg within 30 min, and 97% did so without additional or alternative antihypertensives.At 6 hours after termination of infusion, mean change in NIHSS score was 1.6 (mean baseline 13.7, post-baseline 15.3); and mean change in GCS score was-1.4 (mean baseline 12.9, post-baseline 11.5).Minimal intracerebral hematoma volume change was observed after SBP reduction with clevidipine.In patients requiring intracranial pressure (ICP) monitoring, cerebral perfusion pressure was maintained in an optimal range and no meaningful increases or other changes in ICP were observed.No patients had SBP <90 mmHg within 30 min after clevidipine initiation.Adverse events (AEs) were consistent with previous clinical experience; the most common was pyrexia (7 patients).Hypotension was reported as an AE for 3 patients; BP increased with resolution of AE after clevidipine dose was reduced or the infusion stopped.Conclusions: Clevidipine rapidly and effectively reduces BP in patients with acute ICH and was well tolerated in ACCELERATE patients (n=35), with evidence of a good safety profile consistent with previous experience in other clinical settings.Minimal changes were observed in GCS and NIHSS at 6 hours post-discontinuation and in hematoma volume on 24-hour CT scans.