Risk Factor Analysis on Time to Blood Pressure Control in Spontaneous Intracerebral Hemorrhage Patients

Spontaneous intracerebral hemorrhage (ICH) is the second most common type of stroke accounting for 10-15% of strokes; however, it has the highest mortality, as 40% of patients die within 30 days of the ictus. At the end of 2024, the American Heart Associate (AHA) and American Stroke Association (ASA) published a new quality measure to describe the percentage of patients with spontaneous ICH in whom pharmacologic blood pressure lowering is initiated within 60 minutes of hospital arrival and the target systolic blood pressure (SBP) reached within 120 minutes of hospital arrival. The objective of this study was to evaluate the success of achieving AHA/ASA Quality Measure on time to SBP target attainment at a comprehensive stroke center.

This single-center, retrospective study included adult patients between January 1, 2018, and July 31, 2025, who had confirmed ICH and a SBP greater than 140 mmHg upon arrival to the emergency department. The primary endpoint was incidence of patients who had pharmacological blood pressure lowering agent initiated within 60 minutes and met target SBP within 120 minutes of hospital arrival, which will be followed by a risk factor analysis to evaluate what factors contribute to success in meeting blood pressure target attainment.

Two hundred patients were screened for inclusion, thus far, and of those, 85 were included. Of those, 52.9% of patients were male with a mean age of 66.7 ± 14.5 years. The mean NIHSS was 14.1 ± 11.8, ICH score was 2 ± 1.5, and initial SBP was 169.5 ± 26.6 mmHg. Seventy (82.3%) patients had a pharmacological blood pressure lowering agent initiated within 60 minutes, with a mean time to initiation of 39.3 ± 40.7 minutes. Fifty-four (63.5%) patients met their target SBP within 120 minutes of hospital arrival, with a mean time to SBP at goal of 141.1 ±142.3 minutes. After data collection is complete, a risk factor analysis will be performed.

From preliminary data analysis, timely initiation of pharmacological blood pressure management was achieved in the majority of patients, with most receiving treatment within the recommended 60-minute window. Additionally, nearly two-thirds of patients reached the target SBP within 120 minutes. Overall, these findings support the feasibility of timely SBP intervention in the emergency department while highlighting opportunities to improve the consistency of achieving target SBP goals.