ABSTRACT NUMBER: ESOC2026A1489 TIMELY SYSTOLIC BLOOD PRESSURE TREATMENT AND IN-HOSPITAL OUTCOMES IN PATIENTS WITH INTRACEREBRAL HEMORRHAGE: FINDINGS FROM THE US GET WITH THE GUIDELINES-STROKE REGISTRY

Abstract Background and aims Guidelines recommend rapid treatment of elevated systolic blood pressure (SBP) after intracerebral hemorrhage (ICH). However, contemporary real-world data linking early in-hospital SBP treatment to ICH outcomes are limited. Methods We performed a retrospective cohort analysis of the Hemorrhagic Stroke Data Layer of the American Heart Association Get With The Guidelines-Stroke US National Registry from February 8, 2023 to January 1, 2025. Exposures of interest included symptom onset to SBP treatment initiation (>2 hours vs ≤ 2 hours), and ED arrival to SBP treatment initiation (>1 hour vs ≤ 1 hour), among those with presenting SBP > 149 mmHg. Multivariable models using generalized estimating equations controlled for patient, admission, hospital characteristics, pre-stroke ambulatory status, antiplatelet and anticoagulant use, and stroke severity. The primary outcome was a composite of in-hospital mortality or discharge to hospice. Results 13,136 patients were included. Delayed SBP treatment was associated with worse discharge survival outcomes. Symptom onset to SBP treatment initiation > 2 hours (vs ≤ 2 hours) was associated with higher odds of inpatient mortality or discharge to hospice (aOR 1.16, 95% CI 1.05-1.29, n = 13,136). ED arrival to SBP treatment initiation > 1 hour (vs ≤ 1 hour) was associated with higher odds of inpatient mortality or discharge to hospice (aOR 1.21, 95% CI 1.08-1.36, n = 12,542). Associations with discharge disability measures were directionally inconsistent in some models, suggesting residual confounding. Conclusions In this national US stroke registry, delays to initiation of blood pressure-lowering treatment in patients with ICH were independently associated with higher odds of mortality and discharge to hospice, supporting the importance of rapid SBP treatment workflows for ICH. Conflict of interest Regina Royan, MD, MPH: Nothing to disclose. Brian Stamm, MD, MSc: Nothing to disclose. Raam Pravin: Nothing to disclose. James Cranford: Nothing to disclose. Mariama Runcie: Nothing to disclose. Adam De Havenon, MD: Dr. de Havenon received consulting fees from Novo Nordisk, author fees from UptoDate, and holds equity in Titin KM and Certus. Kori Zachrison, MD: Nothing to disclose. Steven Messe, MD: Dr. Messe holds a pending patent for the monitoring of upper limb movements to detect stroke and holds equity in Neuralert Technologies. Kevin Sheth, MD: Dr. Sheth received grants from the National Institutes of Health, American Heart Association, and Hyperfine; serves on the data safety monitoring board for Phillips and Sense; serves on the scientific advisory board for Astrocyte, BrainQ, Bexorg, and Rhaeos; holds equity in and a patent for Alva. Table 1 - belongs to Results