The purpose of this study is to evaluate the clinical effect of esmolol treatment on cardiac function and electrophysiology; to assess the effects of esmolol treatment on serum adrenergic and cardiac biomarkers; to explore the safety of esmolol treatment shortly after subarachnoid hemorrhage (SAH). Patients will be followed for a maximum of 1 month after the index SAH. The primary outcome will be change in systolic function - ejection fraction by Simpson's rule (baseline versus Day 7 +/- 2 after SAH).
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Inclusion Criteria: * Subarachnoid hemorrhage presumed to be the result of ruptured aneurysm * Age 18 years old or greater * Able to enroll within 24 hours of onset of symptoms * Systolic blood pressure over 140 mm Hg OR administration of antihypertensives after presentation Exclusion Criteria: * Withdrawal of life support imminent (within six hours) * Known heart failure or cardiomyopathy AND ejection fraction 35% or below * Prisoner or pregnant female * Ongoing vasopressor administration to maintain SBP, or clinical suspicion of left ventricular failure * Clinically important arrhythmias (history of cardiac arrest or ventricular arrhythmias), conduction abnormalities (Mobitz Type 2, 3rd degree AV block, or symptomatic Mobitz 1 without pacemaker), clinical cardiogenic shock, or overt clinical heart failure * Active bronchospastic disease (ongoing bronchospasm after SAH presentation or current treatment with oral corticosteroids for asthma or obstructive lung disease) * End stage renal disease