ABSTRACT NUMBER: ESOC2026A1496 BLOOD PRESSURE MANAGEMENT TIMES IN ACUTE INTRACEREBRAL HEMORRHAGE: A 10-YEAR RETROSPECTIVE ANALYSIS

Abstract Background and aims Acute intracerebral hemorrhage (ICH) management is time-sensitive, yet remains poorly standardized compared to ischemic stroke. We evaluated temporal trends in blood pressure (BP) management and hematoma expansion (HE) over a decade. Methods Retrospective study of spontaneous acute ICH patients <24 hours from onset treated at a high-volume academic stroke center (2014-2024). Patients were stratified by time periods (2014-2016/2017-2019/2020-2022/2023-2024). ICH volumes were measured using semi-automated techniques. Revised criteria defined HE: ≥33% relative or ≥6 mL absolute increase in hematoma volume, new or ≥1 mL increase in intraventricular hemorrhage. Results Among 391 patients [mean age 73.9±14 years, 41% female, median NIHSS 19(11-24), baseline hematoma volume 16.2(6.4-37.2)mL], median door-to-target times decreased from 327(157-432) minutes (2014-16) to 119(65-164) minutes (2023-24) (p=0.001), driven by faster treatment-to-target times (268(151-366) to 57(11-105) minutes, respectively , p=0.002). BP treatment times showed sustained improvements across time periods, with significant ordered trends for treatment-to-target (p=0.016) and door-to-target times (p=0.017). The proportion of patients achieving BP <140 mmHg <60 minutes from arrival increased from 4%(2014–2016) to 27%(2023–2024) (linear-by-linear association p=0.04). HE rates trended lower over time (46%(2014-16) to 31%(2023-24), p=0.33). In multivariable analyses, independently predictors of HE included treatment delay >30 minutes (OR 3.2(95%CI 1.6-6.4), p=0.001), diabetes (OR 2.9(1.3-6.3), p=0.007), and hematoma volume (OR 1.03 per mL(1.01-1.05), p<.001), but not time period (p=0.71). Conclusions BP management metrics in acute ICH improved substantially over time. Treatment delay independently predicted HE, underscoring the clinical importance of rapid BP control. Conflict of interest Nothigng to disclose for all authors