(995) Neurologic Outcomes in Patients With Extremely Elevated SBP and ICH After Acute BP Reduction

Introduction: Intracerebral hemorrhage (ICH) is associated with mortality and long-term disability. Hypertension contributes to ICH development and hematoma expansion, while drastic blood pressure reduction may compromise cerebral perfusion. This study aims to compare neurological outcomes in those with extremely elevated systolic BP (EESBP) and elevated systolic BP (ESBP) after a reduction to SBP < 140 mmHg.

Methods: Retrospective, observational chart review of acute SBP reduction in patients with ICH. Adult subjects with ICH and at least one SBP reading >160 mmHg and administration of an antihypertensive within 6 hours of presentation were eligible for inclusion. Excluded patients were those with a premorbid modified Rankin Score (mRS)>4, loss to follow up at 90 days, and death within 24 hours of admission. Patients were assigned to the ESBP group if SBP at presentation was 160–199 mmHg and to EESBP if SBP>200 mmHg. The primary outcome is the mRS at 90 days, and the secondary outcomes are hospital length of stay (LOS), ICU LOS, and 28 day in-hospital mortality.

Results: This study included 56 patients with 29 in the ESBP and 27 in the EESBP groups. There were no significant differences in the demographics, except the average age of 66 in the EESBP and 74 in the ESBP (p=0.04). The primary outcome was achieved by 30% (8/27) versus 38% (11/29) in the EESBP versus ESBP groups, respectively. This led to a risk difference 0.083 (CI -0.3297 to 0.1637), which failed to meet non-inferiority as the confidence interval of the risk difference crossed the non-inferiority margin of 25%. We did not observe a difference in the distribution of mRS scores between the two groups. A trend towards a reduction in hematoma expansion [22% in EESBP versus 10% in ESBP (p=0.14)] and the rates at which the goal SBP was achieved within 6 hours [59% in EESBP versus 79% in ESBP (p=0.10)] was observed. The was no difference in 28-day in-hospital mortality [33% (9/27) in EESBP versus 28% (8/29) in ESBP (p=0.64)], hospital LOS [15.1 days in EESBP versus 7.8 days ESBP (p=0.08)] or ICU LOS [3.9 days in EESBP versus 2.6 days ESBP group (p=0.08)].

Conclusions: This study included patient with SBP>200 mmHg and drastic SBP reduction did not demonstrate an impact on neurological outcomes, 28-day in-hospital mortality, or ICU length of stay.