Abstract TP229: An Intervention to Improve Blood Pressure Lowering Times in Patients Presenting with Intracerebral Hemorrhage

Introduction: Intracerebral hemorrhage (ICH) carries high morbidity and mortality, and early blood pressure (BP) reduction can limit hematoma expansion and improve outcomes. In 2022, the American Heart Association (AHA)/ American Stroke Association (ASA) released updated guidelines for acute BP management in ICH patients, emphasizing lowering BP within one hour of presentation to prespecified target blood pressures and avoiding hypotension. Despite these guidelines, our institution lacked a standardized ED approach. We evaluated the impact of a health system–wide electronic order set designed to standardize SBP management in ICH. Methods: The electronic health record (EHR) order set was developed for ED use to offer physician decisional support for selection of antihypertensives and SBP targets. Prior to order set implementation, our health system targeted SBP <160 in all ICH patients. Our order set included updated guidelines to lower SBP based on presenting BP: in patients with SBP > 220, target SBP was 180-200, and for patients with SBP <220, target SBP was 130-150. We compared ED patients with nontraumatic ICH presenting one year before (July 2023–June 2024) and after (Aug 2024–June 2025) initiation. Outcomes assessed were the proportion achieving SBP goal within one hour of presentation or head CT, median time to goal SBP, hypotension (SBP <90), and order set utilization. Results: The order set was implemented in August 2024. Pre-implementation (n=44) and post-implementation (n=48) groups were identified. Order set use increased from 26% during August-December 2024 to 61% during January-June 2025. SBP goal within one hour of presentation was achieved in 18% pre- and in 30% post-order set. SBP goal within one hour of head CT was achieved in 34% prior to and 52% post-order set. Median time to goal SBP improved from 118 to 103 minutes from door presentation, and from 80 to 54 minutes after head CT. Hypotension, defined as SBP <90, decreased from 14.5% pre- to 7.5% post-order set. Conclusion: Compliance with guideline directed SBP lowering in ICH was low but improved after implementing a standardized ED order set. Adoption increased over time, with trends toward faster goal attainment and fewer hypotensive episodes. This systemwide initiative demonstrates the feasibility and safety of using EHR-based tools to improve acute BP management in ICH, and highlights opportunities for further adherence and outcome optimization.