Abstract Background and aims Acute intracerebral hemorrhage (ICH) management is time-sensitive, yet remains poorly standardized. We evaluated current time metrics for acute blood pressure (BP) reduction in ICH in a high-volume academic center, and assessed their effects on hematoma expansion (HE). Methods Retrospective study of consecutive patients with spontaneous ICH 24 hours from onset (01/2014-06/2024). ICH volumes were quantified using semi-automated techniques. HE was defined as per revised criteria: ≥33% relative or ≥6mL absolute increase in hematoma volume, new or ≥1mL increase in intraventricular hemorrhage. Results Among 391 patients (mean age 73.9±14.1 years, 41% female, median(IQR) NIHSS 19(11-24), median baseline hematoma volume 16.2(6.4-37.2) mL, and mean baseline systolic BP 179.5±34.0 mmHg), 301(77%) received antihypertensive treatment. Median arrival-to-treatment time was 26(14-41.5) minutes, and median time-to-BP target was 83(38.5-162) minutes, with 112 (37.2%) reaching target ≤60 minutes, and 67(22.3%) ≤30 minutes. Among 342(87%) patients with follow-up imaging, 101(29.5%) experienced HE. Median time-to-BP target was similar between HE+ (86(32-150)min) and HE- patients (75.5(43-161), p=0.99). The proportion of HE was higher with treatment delays 30 minutes from arrival (36(47%)) versus ≤30 minutes (32(26%)) (p=0.002). On multivariate analyses, iindependent predictors of HE included treatment delay 30 minutes (OR 3.0(95%CI 1.5–5.9), diabetes (OR 3.4(1.5-7.7), and baseline hematoma volume (OR 1.03(1.01–1.05) per mL). Conclusions Only 22%-38% of treated patients achieved BP targets ≤30 minutes and ≤60 minutes from arrival. Treatment delays predict hematoma expansion, highlighting the need for improved acute ICH management. Conflict of interest Nothigng to disclose for all authors
Godin et al. (Fri,) studied this question.