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.