Abstract WP222: In-Hospital Outcomes in those with Severe versus Mild-Moderate Hypertension after Spontaneous Intracerebral Hemorrhage

Background: Patients with spontaneous intracerebral hemorrhage (SICH) who present with severe hypertension (SHTN; systolic blood pressure SBP >220 mmHg) have been underrepresented in major SICH trials. Consequently, current management strategies for SHTN are extrapolated from studies of patients with mild to moderate hypertension (mmHTN; SBP 140–220 mmHg). Whether these two groups differ in clinical characteristics and outcomes remains uncertain. Methods: We prospectively enrolled consecutive patients with SICH between October 2024 and June 2025 at a large academic center in the southeastern United States. Eligible patients were adults (≥18 years) with confirmed SICH and an initial SBP ≥140 mmHg. Baseline demographics, clinical characteristics, and in-hospital outcomes were abstracted from the electronic medical record. The primary outcome was in-hospital mortality, and the primary exposure was SBP at presentation, categorized as SHTN (SBP >220 mmHg) or mmHTN (SBP 140–220 mmHg). Binomial logistic regression was used to identify predictors of in-hospital mortality. Results: Fifty six were enrolled (6 with SHTN, 50 with mmHTN). Compared with mmHTN patients, those with SHTN were younger (mean age 58 SD 7.8 vs. 64 11.8), more often male (66.7% vs. 54.0%), and more likely to have a history of hypertension (100% vs. 88%). The initial Glasgow Coma Scale score was lower in the SHTN group (9 5 vs. 11 5), and mean presenting SBP was higher (234 17.4 vs. 165 27 mmHg). SHTN patients more frequently had intraventricular hemorrhage (67% vs. 52%), higher baseline ICH scores (2.5 vs. 1.6), and higher rates of intubation (33% vs. 16%). However, baseline ICH volumes were similar (11.6 vs. 12.4 mL). Positive urine drug screens for cocaine (17% vs. 6%) and amphetamines (17% vs. 4%) were more common in the SHTN group. In-hospital mortality was 17% in SHTN and 28% in mmHTN. ICH volume was the only predictor of in-hospital mortality (odds ratio OR 1.1; p=0.02), while SHTN was not (OR 0.48; p=0.59). Conclusions: Patients with SICH and SHTN may differ in their presenting characteristics compared with those with mmHTN. However, ICH volume and not SHTN, was the only predictor of in-hospital mortality. Larger studies are warranted to better clarify the impact of SHTN on outcomes (death and disability) to guide blood pressure management in this high-risk population.