Blood pressure control before and after spontaneous intracerebral haemorrhage: a stroke service audit and strategies for improvement

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Spontaneous intracerebral haemorrhage (ICH) (n=89). Intervention: Post-intracerebral haemorrhage antihypertensive management vs. Pre-intracerebral haemorrhage baseline management. Primary outcome: Systolic blood pressure (mmHg) and blood pressure target achievement (<140/90 mmHg NICE and <130/80 mmHg ESO) post-ICH versus pre-ICH (Median SBP reduction 12.0 mmHg, p=<0.001).

Q: What does this research mean for the field?

Antihypertensive intensification after spontaneous intracerebral haemorrhage lowers median systolic blood pressure, yet persistent care gaps leave over 40% of patients uncontrolled prior to haemorrhage and over 60% above secondary-prevention targets post-discharge. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Claudia Zeicu; David John Werring; Marc Jonathan George

doi:10.1038/s41371-026-01243-5

October 23, 2026Journal of Human HypertensionOpen Access

Blood pressure control before and after spontaneous intracerebral haemorrhage: a stroke service audit and strategies for improvement

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Why the study?

This audit evaluated blood pressure control and antihypertensive prescribing before and after spontaneous intracerebral haemorrhage to identify primary- and secondary-prevention gaps and strategies for improvement.

Key Points

To evaluate blood pressure control and antihypertensive management across the entire care pathway before and after spontaneous intracerebral haemorrhage.
Retrospective audit of N=89 adults with CT-confirmed spontaneous intracerebral haemorrhage admitted between 1 January 2023 and 1 January 2025 at a UK tertiary neuroscience centre.
Primary care blood pressure records within 12 months pre-admission were compared with inpatient and post-discharge community readings against NICE (<140/90 mmHg) and ESO (<130/80 mmHg) targets.
In the 12 months before haemorrhage, only 50 of 89 patients (56.2%, 95% CI 45.8–66.0) met the NICE target despite 71 of 89 (79.8%) having known hypertension.
Following discharge, NICE target attainment rose to 74 of 86 patients (86.0%) and median systolic blood pressure fell by 12.0 mmHg (p < 0.001), but only 33 of 86 (38.4%) achieved the ESO secondary-prevention threshold.
The first documented community blood pressure check occurred a median of 62 days after discharge (IQR 22–170).

Study Design

Type

Observational (n=89)

Multicenter

No

Structured PICO

P

Population

89 adult survivors of CT-confirmed spontaneous intracerebral haemorrhage (median age 67.9 years, 40.4% female, 79.8% with known hypertension) at a UK tertiary neuroscience centre with pre-admission and post-discharge primary-care blood pressure records.

E

Exposure

Routine inpatient and community blood pressure management and antihypertensive prescribing across the ICH care pathway (pre-ICH, admission, discharge, and post-discharge periods)

O

Outcome

Proportion of patients achieving blood pressure control against NICE (<140/90 mmHg) and ESO (<130/80 mmHg) targets across the pre-ICH, admission, discharge, and post-discharge periodssurrogate

Main Result

Effect estimate: Median SBP reduction 12.0 mmHg

Absolute Event Rate: 127% vs 139%

p-value: p=<0.001

This retrospective clinical audit reveals substantial primary- and secondary-prevention blood pressure control gaps in spontaneous intracerebral haemorrhage patients, with over 40% uncontrolled prior to the event and 61.6% remaining above the ESO <130/80 mmHg target post-discharge alongside a median 62-day delay to community follow-up.

Limitations

Single-centre retrospective audit design
Restricted to patients alive at data extraction with pre-admission BP data accessible through the London Care Record, introducing selection and survival bias
Opportunistic GP blood pressure recording with sparse readings may underestimate the true burden of uncontrolled hypertension
Discharge prescribing reflects clinical intent rather than confirmed long-term medication adherence
Single-centre retrospective audit
Restricted to patients with pre-admission BP data accessible through the London Care Record and alive at data extraction, introducing potential selection and survival bias
Opportunistic GP recording may underestimate the true burden of uncontrolled hypertension
Discharge prescribing reflects intent rather than long-term adherence

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Implication

Gaps in post-ICH BP control persist after intensification; leaves open whether structured pathways enhance secondary prevention.

Abstract

In a retrospective audit of 89 adults with spontaneous intracerebral haemorrhage (ICH) at a tertiary neuroscience centre, fewer than 60% met the National Institute for Health and Care Excellence (NICE) blood pressure (BP) target in the year before their haemorrhage, despite most carrying a known diagnosis of hypertension. Blood pressure control and antihypertensive prescribing improved after ICH, yet most survivors remained above the European Stroke Organisation (ESO) secondary-prevention target, and the first documented community BP check occurred a median of 62 days after discharge. These findings expose primary- and secondary-prevention gaps spanning the whole care pathway and lend support to a structured, protocolised uptitration pathway after discharge, combining remote BP monitoring with pharmacist- or nurse-led dose escalation.

Discussion

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Cite This Study

Zeicu et al. (2026) conducted an observational in Spontaneous intracerebral haemorrhage (ICH) (n=89). Post-intracerebral haemorrhage antihypertensive management vs. Pre-intracerebral haemorrhage baseline management was evaluated on Systolic blood pressure (mmHg) and blood pressure target achievement (<140/90 mmHg NICE and <130/80 mmHg ESO) post-ICH versus pre-ICH (Median SBP reduction 12.0 mmHg, p=<0.001).

synapsesocial.com/papers/6adc966ca704d151585a5e94 https://doi.org/10.1038/s41371-026-01243-5

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Blood pressure control before and after spontaneous intracerebral haemorrhage: a stroke service audit and strategies for improvement

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Blood pressure control before and after spontaneous intracerebral haemorrhage: a stroke service audit and strategies for improvement

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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