ABSTRACT NUMBER: ESOC2026A618 CHRONIC ANTIHYPERTENSIVE THERAPY AND ACUTE ISCHEMIC STROKE: LIMITED IMPACT OF ANTIHYPERTENSIVE DRUG CLASSES ON ADMISSION BLOOD PRESSURE, STROKE SEVERITY AND HEMORRHAGIC TRANSFORMATION

Abstract Background and aims The influence of chronic antihypertensive therapy (AHT) on acute ischemic stroke (AIS) presentation and early complications remains unclear. Whether specific antihypertensive drug classes affect admission systolic (SBP) and diastolic blood pressure (DBP), neurological severity, or hemorrhagic transformation (HT) is clinically relevant. Methods We analyzed consecutive patients with AIS hospitalized within 24 hours of symptom onset and reliable medical history. Multivariable linear regression assessed associations between pre-stroke antihypertensive drug classes (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers, diuretics, and calcium channel blockers) and SBP and DBP, as well as NIHSS score. Multivariable logistic regression evaluated predictors of HT. Models were adjusted for age, sex, time from symptoms onset, number of antihypertensive drugs, atrial fibrillation, diabetes mellitus, large vessel occlusion status, stroke territory and acute reperfusion therapies. Results Overall, 403 patients were included. The number of chronic antihypertensive medications was not independently related to admission SBP, DBP or NIHSS score. Beta-blocker therapy was associated with higher SBP (+12.1 mmHg, 95% CI 2.2–22.0; p = 0.017), while no such association was observed for other classes. No antihypertensive class was related to DBP, NIHSS or HT. Higher admission NIHSS increased the risk of HT (OR 1.08, 95% CI 1.02–1.14; p = 0.010) whereas mechanical thrombectomy was associated with a lower risk (OR 0.19, 95% CI 0.07–0.48; p < 0.001). Conclusions In patients hospitalized within 24 hours of AIS onset, admission BP, neurological severity, and hemorrhagic transformation are driven predominantly by acute stroke-related factors rather than by the intensity or class of AHT. Conflict of interest Magdalena Targosz-Gajniak: nothing to disclose. Jakub Malkiewicz: nothing to disclose. Patrycja Radecka: nothing to disclose. Dawid Arkuszewski: nothing to disclose. Daria Hurtova: nothing to disclose. Agnieszka Buchta: nothing to disclose. Klaudia Giercuszkiewicz-Haśnik: nothing to disclose. Michalina Kukla: nothing to disclose. Natalia Pabiś-Płotkowska: nothing to disclose. Joanna Siuda: nothing to disclose.