Objectives <p>This study aimed to identify distinct longitudinal trajectories of estimated pulse wave velocity (ePWV) during the acute phase of intracerebral hemorrhage (ICH) and to evaluate their association with 28-day mortality, comparing their prognostic value against a single baseline ePWV measurement.</p> Methods <p>Adult patients with ICH admitted to the ICU were included. Latent class growth mixed modeling was applied to identify distinct ePWV trajectories. The primary outcome was 28-day all-cause mortality. Kaplan–Meier analysis and multivariable Cox proportional hazards models were used to assess the associations between ePWV trajectories and mortality.</p> Results <p>Among 3420 critically ill ICH patients included, four distinct ePWV trajectories were identified: Class 1 (initial decrease followed by an increase), Class 2 (stable moderate-to-high), Class 3 (stable low), and Class 4 (persistent decrease). Patients in Class 1 had the highest 28-day mortality rate, followed by Class 4. After adjusting for confounders, both Class 1 and Class 4 were independently associated with significantly increased mortality risk compared to Class 3. In contrast, a single initial ePWV measurement was not significantly associated with mortality after multivariable adjustment.</p> Conclusions <p>Dynamic ePWV trajectories during the acute phase of ICH may provide additional prognostic information beyond a single baseline measurement. Specifically, Class 1 and Class 4 were independently associated with increased 28-day mortality, though these findings should be interpreted with caution given the limited sample size of certain trajectory classes.</p>