Background: Elevated systolic blood pressure (SBP) is common in acute intracerebral hemorrhage (ICH). While early BP lowering is evidence-based and guideline-recommended, the factors associated with higher presenting SBP and the relationship with in-hospital outcomes across the full SBP spectrum remain unclear. Methods: This was a retrospective cohort analysis of the Hemorrhagic Stroke Data Layer of the American Heart Association Get With The Guidelines-Stroke National Registry from Feb 8, 2023 to Jan 1, 2025. Patients with ICH were categorized by presenting SBP: normal (45, Black and Asian race (vs White), history of hypertension, renal insufficiency, and increasing stroke severity as measured by NIHSS were associated with higher odds of elevated presenting SBP. History of prior stroke, private transportation method, and use of pre-ICH antithrombotic agents were associated with lower odds of elevated presenting SBP (Figure 1A-B). There were non-linear associations between presenting SBP and odds of ambulation at discharge (reverse U-shape) and discharge to home (reverse J-shape) (Figure 2A-B). There was a U-shaped association between presenting SBP and odds of death or discharge to hospice and discharge mRs of 3-6 (vs 0-2) (Figure 3A-B). Discussion: Presenting SBP in ICH exhibits a U-shaped association with mortality and functional outcomes, with both extremes associated with higher risk. These findings suggest that avoiding both under- and over-treatment may be critical in early ICH care. Prospective studies should evaluate whether there is a time treatment interaction with rapid SBP reduction, especially at the high end of this curve.
Royan et al. (2026) studied this question.