In-hospital Outcomes Among Patients with Severe vs Mild-moderate Hypertension Following Spontaneous Intracerebral Hemorrhage
Parth Patel1, Sam Natla1, Priyanka Menon1, Anthony Elengickal1, Srijita Nandy1, Nicole Tayag1, Mashoor Ahammed1, Askiel Bruno2, Manan Shah3, Ashutosh Pandey4, Klepper Alfredo Garcia4, Amir Mbonde1
1Medical College of Georgia, 2Medical College of Georgia, Augusta University, 3Augusta University Medical Center, Dept Of Neurology, 4Augusta University - Neurocritical Care Division
Objective:
To compare clinical characteristics, treatment responses, and outcomes in patients with spontaneous intracerebral hemorrhage (SICH) presenting with severe hypertension (sHTN; systolic blood pressure [SBP] >220 mmHg) versus mild to moderate hypertension (mmHTN; SBP 140–220 mmHg).
Background:
Patients with SICH and sHTN are underrepresented in major clinical trials due to restrictive eligibility criteria. Consequently, current BP management strategies are largely based on data from patients with mmHTN, and potential differences in presentation or outcomes between these groups remain poorly defined.
Design/Methods:
We retrospectively reviewed records of adults patients admitted with SICH to a tertiary center in the Southeastern US (January–December 2020; October 2024–June 2025). Patients were categorized as sHTN or mmHTN. Baseline characteristics, clinical features, and in-hospital outcomes were compared using Mann–Whitney U, chi-square, or Fisher’s exact tests. Logistic regression identified independent predictors of in-hospital mortality.
Results:
Among 147 patients (median age 63 years, 61% male), 15 (10%) had sHTN. Compared with mmHTN, sHTN patients tended to be younger, more often male, universally had a history of hypertension, and had higher rates of positive urine drug screen, although these differences were not statistically significant. Those with sHTN had significantly longer hospital stays (median 16 vs. 9 days; p=0.013). Hemorrhage volumes, locations, and neurological severity scores were similar between groups. In-hospital mortality did not differ significantly (sHTN, 17% vs. mmHTN, 28%, p=0.55). On multivariable analysis, larger ICH volume (OR 1.04; p=0.0046) and intraventricular hemorrhage, IVH (OR 4.91; p=0.0029) independently predicted mortality, but sHTN was not associated with mortality.
Conclusions:
Despite a longer hospital stay, patients with SICH and sHTN are not at an increased risk of mortality when compared to those with mmHTN. Admission ICH volume and IVH were significant predictors of mortality. Larger cohort studies are needed to clarify the prognostic impact of sHTN in SICH.
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