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Background <p>Optimal systolic blood pressure (SBP) management is central to acute intracerebral hemorrhage (ICH) care. Although dynamic BP trajectories and BP variability have been investigated in broader cerebrovascular populations, evidence specifically addressing early hourly SBP trajectories after ICH in township–hospital settings remains limited. Whether early SBP trajectories after admission to the neurology ward are associated with clinical outcomes in this real-world setting remains unclear.</p> Methods <p>We conducted a retrospective cohort study of adults with spontaneous supratentorial ICH admitted to a township hospital in China between January 2023 and August 2025. Hourly SBP measurements during the first 24&#xa0;h after admission to the neurology ward were included in the trajectory analysis. Latent class linear mixed modeling was applied to identify distinct SBP trajectories. The primary outcome was 90-day functional status assessed by the modified Rankin Scale (mRS), categorized as 0–2, 3–4, and 5–6 and analyzed using ordinal logistic regression. Secondary outcomes included favorable functional outcomes (mRS 0–1, 0–2, and 0–3) and 90-day all-cause mortality. Multivariable models sequentially adjusted for demographics, stroke severity, total hemorrhage volume, vascular comorbidities, and lifestyle factors. The extended adjustment model was exploratory and was not intended for causal inference.</p> Results <p>Among 223 patients, three SBP trajectories were identified: persistently elevated SBP (class 1, <i>n =</i> 12), moderately declining SBP (class 2, <i>n =</i> 167), and low-level declining SBP (class 3, <i>n =</i> 44). Compared with class 1, class 2 and class 3 showed lower odds of worse 90-day functional outcomes in the extended ordinal regression model (class 2: OR, 0.21; 95% CI 0.06–0.75; class 3: OR, 0.20; 95% CI 0.05–0.81). Among secondary outcomes, only mRS 0–2 showed a similar adjusted association, whereas mRS 0–1, mRS 0–3, and mortality were not statistically significant after adjustment.</p> Conclusions <p>Early SBP trajectories within the first 24&#xa0;h after admission to the neurology ward were associated with 90-day functional outcomes in patients with spontaneous supratentorial ICH treated in a township hospital. Given the small size of the persistently elevated SBP class and the imbalance in antihypertensive treatment exposure across classes, these findings should be considered exploratory and require validation in larger prospective studies.</p>

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Early systolic blood pressure trajectories and 90-day outcomes after spontaneous supratentorial intracerebral hemorrhage in a township hospital

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月5日

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  • Yong He,
  • Runzhui Lin,
  • Yuzhang Bei,
  • Shuangxi Cheng,
  • Jianhuang Chen,
  • Tieshi Zhu

摘要

Background

Optimal systolic blood pressure (SBP) management is central to acute intracerebral hemorrhage (ICH) care. Although dynamic BP trajectories and BP variability have been investigated in broader cerebrovascular populations, evidence specifically addressing early hourly SBP trajectories after ICH in township–hospital settings remains limited. Whether early SBP trajectories after admission to the neurology ward are associated with clinical outcomes in this real-world setting remains unclear.

Methods

We conducted a retrospective cohort study of adults with spontaneous supratentorial ICH admitted to a township hospital in China between January 2023 and August 2025. Hourly SBP measurements during the first 24 h after admission to the neurology ward were included in the trajectory analysis. Latent class linear mixed modeling was applied to identify distinct SBP trajectories. The primary outcome was 90-day functional status assessed by the modified Rankin Scale (mRS), categorized as 0–2, 3–4, and 5–6 and analyzed using ordinal logistic regression. Secondary outcomes included favorable functional outcomes (mRS 0–1, 0–2, and 0–3) and 90-day all-cause mortality. Multivariable models sequentially adjusted for demographics, stroke severity, total hemorrhage volume, vascular comorbidities, and lifestyle factors. The extended adjustment model was exploratory and was not intended for causal inference.

Results

Among 223 patients, three SBP trajectories were identified: persistently elevated SBP (class 1, n = 12), moderately declining SBP (class 2, n = 167), and low-level declining SBP (class 3, n = 44). Compared with class 1, class 2 and class 3 showed lower odds of worse 90-day functional outcomes in the extended ordinal regression model (class 2: OR, 0.21; 95% CI 0.06–0.75; class 3: OR, 0.20; 95% CI 0.05–0.81). Among secondary outcomes, only mRS 0–2 showed a similar adjusted association, whereas mRS 0–1, mRS 0–3, and mortality were not statistically significant after adjustment.

Conclusions

Early SBP trajectories within the first 24 h after admission to the neurology ward were associated with 90-day functional outcomes in patients with spontaneous supratentorial ICH treated in a township hospital. Given the small size of the persistently elevated SBP class and the imbalance in antihypertensive treatment exposure across classes, these findings should be considered exploratory and require validation in larger prospective studies.