Abstract Number: Esoc2026a1480 Suboptimal Time Metrics for Blood Pressure Reduction in Acute Intracerebral Hemorrhage: Impact on Hematoma Expansion

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