ABSTRACT NUMBER: ESOC2026A1279 RACE AND SOCIAL DISPARITIES IN BLOOD PRESSURE CONTROL BEFORE AND AFTER INTRACEREBRAL HEMORRHAGE

Abstract Background and aims Blood pressure (BP) control is crucial for secondary prevention after intracerebral hemorrhage (ICH), yet control often remains suboptimal, particularly among racial minorities and socioeconomically disadvantaged populations. We compared the relationship between pre- and post-ICH BP control across racial and socioeconomic groups in the U.S. Methods We conducted a case-only study within the NIH All of Us Research Program. ICH survivors were identified from electronic health records using SNOMED and ICD codes. Systolic BP measurements were classified as pre-ICH (1-365 days before) and post-ICH (30-365 days after). Neighborhood deprivation was defined by 3-digit ZIP code deprivation index tertiles relative to the population. The primary outcome was uncontrolled mean systolic BP (≥140 mmHg). Adjusted logistic regression estimated the odds of uncontrolled post-ICH BP and causal mediation analysis quantified the contribution of pre-ICH BP to post-ICH disparities. Results Among 1,872 ICH survivors (mean age 61.0 years; 49.5% female), Black participants had higher rates of uncontrolled BP than White participants pre-ICH (42.4% vs 22.7%; p<0.001) and post-ICH (33.7% vs 16.3%; p<0.001). Deprived neighborhoods were also associated with worse BP control pre-ICH (29.8% vs 22.4%; p=0.018) and post-ICH (23.5% vs 13.8%; p<0.001). In adjusted models, Black race (OR 3.06, 95% CI 2.17-4.32) and neighborhood deprivation (OR 1.64, 95% CI 1.14–2.34) were associated with uncontrolled post-ICH BP. Pre-ICH BP mediated 28% of the racial disparity and 24% of the deprivation disparity in post-ICH BP control. Conclusions Pre-ICH BP disparities substantially mediate post-ICH control gaps, highlighting the need for both upstream hypertension management and equitable post-stroke care. Conflict of interest nothing to disclose