Abstract Body: Introduction:
Blood pressure is a simple physiologic parameter that is always measured, can be modulated, and may affect the outcome. In the hyperacute window, the therapeutic priorities are aimed at preserving penumbral tissue prior to reperfusion with the aim to optimize the chances of improved outcomes.
Blood pressure fluctuations early in the stroke can be a predictor of morbidity and mortality, and both high and low systolic blood pressures can negatively affect neurological outcome.

Objectives
Investigate the effects of admission systolic blood pressure (aSBP) on outcomes in patients with acute ischemic stroke (AIS), with or without large vessel occlusion (LVO).

Methods:
This was a retrospective analysis of AIS patient data from a health system’s stroke registry for patients discharged between January 2018 and March 2024.
Adult (18+ yo) AIS patients with recorded aSBP to Thrombectomy Capable, Primary Stroke Plus or Comprehensive Stroke Center certified sites were included.
Discharge disposition (DD) was dichotomized as poor DD (Hospice, Expired) and favorable DD (Home, SNF/LTC, IRF) while the 90-day modified Rankin Scale (mRS) dichotomized as good outcome (0-2) and unfavorable outcome (3-6).
The relationship between the aSsBP , DD and 90-day mRS was analyzed using restricted cubic splines through multivariable mixed-effect models, adjusting for age, sex, race/ethnicity, NIHSS, treatment modalities, and medical history.

Results:
Data from 21,759 AIS patients were included, 72% aged ≥65 years, 49% female, 68% white, had median aSBP at admission 152 mmHg [interquartile range (IQR) 135, 172]; 3,016 (14%) had LVO.
Low aSBP is independently associated with reduced probability of good clinical outcomes (favorable DD and good 90-day mRS) overall and if LVO. (Table 1) The higher probability of good clinical outcome was found from approximately 150 mmHg, when it plateaus, to 180 mmHg.

Conclusions:
The term permissive hypertension is unique to each patient and needs to be optimized accordingly to achieve the best clinical outcome. This data will be beneficial in educating medical staff and making sure to optimize blood pressure especially during transfer to a certified stroke center.