High in-hospital blood pressure variability and severe disability or death in primary intracerebral hemorrhage patients

Abstract

Objective To quantify in-hospital systolic blood pressure variability among patients with intracerebral hemorrhage, determine the association between high systolic blood pressure variability (HSBPV) and 90-day severe disability or death, and examine the association between pre-hospital factors and HSBPV. Methods Adult, radiologically confirmed, intracerebral hemorrhage patients enrolled in a multi-site cohort were included. Using a semi-automated algorithm, systolic blood pressure values recorded from routine non-invasive systolic blood pressure monitoring in critical and acute care settings were extracted for the duration of hospitalization. Inter and intra-patient systolic blood pressure variability was quantified using generalized estimating equation methods. Modified Poisson and logistic regression models were fit to determine the association between HSBPV and 90-day severe disability or death and between pre-hospital characteristics and HSBPV, respectively. Results A total of 566 patients managed at four certified stroke centers were included. Over 120,000 systolic blood pressure readings were analyzed, and a standard deviation (SD) of 13.0 was parameterized as a cut-off point to categorize HSBPV. Patients with HSBPV had a greater risk of 90-day severe disability or death (relative risk: 1.20, 95% confidence interval: 1.04–1.39), after controlling for age, pre-morbid functional status, and other disease severity measures. Greater likelihood of in-hospital HSBPV was independently observed in elderly, female patients, and in patients with high admission systolic blood pressure. Conclusion Quantification of HSBPV is feasible utilizing routinely collected systolic blood pressure readings, and a singular cut-off parameter for systolic blood pressure variability demonstrated association with 90-day severe disability or death. Elderly, female, and patients with high admission systolic blood pressure may be more likely to demonstrate HSBPV during hospitalization.

Which Parameters of Beat-to-Beat Blood Pressure Best Predict Poor In-Hospital Outcome in Spontaneous Intracerebral Hemorrhage?

“…Moreover, SBP-CV predicted poor outcome better than DBP-CV according to ROC curves. Several previous studies have demonstrated that there is a stronger predictive function of short-term and longterm SBPV than DBPV in patients with ischemic or hemorrhagic stroke (Rothwell et al, 2010;Geeganage et al, 2011;Endo et al, 2013;Rodriguez-Luna et al, 2013;Chung et al, 2018;Divani et al, 2019;Meeks et al, 2019). This finding suggests that SBPV is more critical than DBPV for ICH prognosis, not only in short-term and long-term recordings, but also in beat-tobeat measurements.…”

“…BPV is primarily divided into the three following categories: long-term (days to months), short-term (minutes to hours), and very shortterm (beat-to-beat) BPV (Parati et al, 2013). Most previous studies in patients with ICH have focused on the first two types of BPV and have reported that an increased BPV during both acute and subacute stages was independently associated with worse functional outcomes at 3 months (Manning et al, 2014;Tanaka et al, 2014;Lattanzi et al, 2015;Chung et al, 2018;de Havenon et al, 2018;Meeks et al, 2019). Tanaka et al and Rodriguez-Luna et al further revealed that SBPV was correlated with early neurological deterioration (Rodriguez-Luna et al, 2013;Tanaka et al, 2014).…”

Systolic Blood Pressure Variability When Transitioning From Intravenous to Enteral Antihypertensive Agents in Patients With Hemorrhagic Strokes

“…In our study, HR variability was not affected by the overlap time or number of enteral antihypertensives used, which might be related to the class of antihypertensive agents used during this process. Previous studies have investigated SBPV using IV antihypertensive agents in patients with ICH and SAH (13)(14)(15)(20)(21)(22). In a study by Liu-DeRyke et al, 28 patients on labetalol were compared to 26 patients receiving nicardipine.…”

Hypertensive Crisis in Acute Cerebrovascular Diseases Presenting at the Emergency Department: A Narrative Review

“…In patients with TIA or ischemic stroke, BP variability is associated with an increased risk of vascular events, including stroke, coronary artery disease, and heart failure [ 133 , 134 ]. In ICH patients, high in-hospital BP variability is associated with severe disability or death, especially elderly patients, female patients, and patients with high admission SBP [ 135 ]. In these cases, antihypertensive drugs should target a lowering of both mean BP and BP variability.…”