ABSTRACT NUMBER: ESOC2026A2141 BLOOD PRESSURE CONTROL WITH CLEVIDIPINE IS ASSOCIATED WITH HEMATOMA VOLUME REDUCTION IN ACUTE HYPERTENSIVE INTRACEREBRAL HEMORRHAGE: A SINGLE-CENTER CASE-SERIES STUDY

Abstract Background and aims Intracerebral haemorrhage (ICH) is associated with unfavourable functional outcomes and increased mortality, largely due to hematoma size and expansion. Prompt blood pressure (BP) lowering may limit hematoma growth. We sought to investigate the effect of clevidipine, an intravenously administered calcium channel blocker, on ICH volume reduction and functional outcomes compared with standard antihypertensive therapy in hypertensive ICH patients. Methods We conducted a prospective case–series study evaluating serial hematoma volume measurements, and clinical outcomes in acute hypertensive ICH patients receiving intravenous clevidipine (2023-2025) versus standard antihypertensive treatment with labetalol, clonidine and/or diuretics (2020-2022; no availability of clevidipine). Results Sixty-four patients (cases:25; historical controls:39) were included. There was no difference in demographic characteristics and admission National Institutes of Health Stroke Scale (NIHSS) scores. Clevidipine-use resulted in effective BP control (<140/90mmHg) within 3.5±3.2 hrs from treatment onset in all cases. A statistically significant ICH-volume reduction on 24-hr follow-up brain-CT was observed in the clevidipine group (14.7% vs 4.5% in controls; p=0.023). Hematoma expansion was documented in 0% and 7.7% of cases and controls (p=0.172) respectively. The reduction in NIHSS-score during hospitalization, 3-month modified-Rankin-Scale scores and mortality were similar in the two groups. No serious adverse events were reported in cases. In multivariable linear regression models adjusting for potential confounders, clevidipine-use was independently associated with greater ICH-volume reduction (β=−0.16, 95%CI: −0.30, −0.02, p=0.024). Conclusions The present study highlights that clevidipine is a safe and effective option for acute BP management in patients with hypertensive ICH and may limit hematoma expansion. Conflict of interest Nothing to disclose.