Regulating Blood Pressure During Recovery From Intracerebral Hemorrhage and Ischemic Stroke

Inclusion Criteria:

1. Age ≥ 18 years

2. Symptomatic ICH confirmed by head CT or brain MRI during hospitalization OR ischemicstroke patients. Ischemic stroke will be defined by focal signs/symptoms of anyduration associated with evidence of acute arterial infarction on neuroimaging orclinical evidence of cerebral focal arterial ischemic injury with symptomspersisting ≥ 24 hours.

3. Written, informed consent by patient or surrogate

4. Ability to comply with all study procedures and available for the duration of thestudy

Exclusion Criteria:

1. Secondary ICH due to trauma, vascular malformation, or tumor

2. Life expectancy < 1 year

3. eGFR <45

4. Serum potassium greater than or equal to the upper limit of normal of the lab on thetwo most recent consecutive potassium levels prior to enrollment

5. Known hypersensitivity to spironolactone

6. Upper arm greater than 17 inches in circumference

7. Pregnancy, planned pregnancy, or breastfeeding

8. Contraindication to discontinuing mineralocorticoid antagonist therapy for 3-12months per the investigator's discretion (e.g., refractory proteinuria)

9. Systolic BP >200 mmHg or diastolic BP >110 mmHg at the time of randomization

10. Systolic BP <120 mmHg at the time of randomization

11. Any condition which, in the judgement of the investigator, increases the risk to thepatient

12. History of Addison's disease