Increased Blood Pressure Variability Contributes to Worse Outcome After Intracerebral Hemorrhage

Havenon, Adam de; Majersik, Jennifer J.; Stoddard, Gregory J.; Wong, Ka Ho; McNally, J. Scott; Smith, A. Gordon; Rost, Natalia S.; Tirschwell, David

doi:10.1161/strokeaha.118.022133

Cited by 40 publications

(34 citation statements)

References 7 publications

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“…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).…”

Section: Discussionmentioning

confidence: 99%

“…However, a meta-analysis of five randomized, controlled, single/doubleblinded, parallel trials found no differences between aggressive and conservative BP-lowering strategies in the incidence rates of 3-months mortality and early neurological deterioration (Lattanzi et al, 2017). Post hoc analyses of the Field Administration of Stroke Therapy-Magnesium trial, Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial, and Antihypertensive Treatment of Acute Cerebral Hemorrhage II trial showed that increased BP variability (BPV) was associated with a poor functional outcome (Manning et al, 2014;Chung et al, 2018;de Havenon et al, 2018). This indicated that, in addition to the absolute BP level, BPV might also be a significant risk factor for worse outcomes after ICH.…”

Section: Introductionmentioning

confidence: 99%

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

Guo

Reziya

et al. 2020

Front. Aging Neurosci.

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Objective: There is increasing evidence that high blood pressure (BP) levels and BP variability (BPV) over 24 h or longer are associated with poor clinical outcomes in patients with intracerebral hemorrhage (ICH). The objective of this study was to examine the association between different beat-to-beat BP parameters and in-hospital outcomes. Methods: Patients with a diagnosis of acute spontaneous ICH were recruited consecutively and prospectively between September 2018 and January 2019. Beat-to-beat recordings were measured non-invasively for 5 min within the first 72 h after the onset of symptoms. BPV was analyzed by standard deviation (SD), coefficient of variation (CV), average real variability (ARV), and variation independent of mean (VIM). Outcome was assessed at discharge using the modified Rankin Scale (mRS) score. Multivariate logistic regression analysis was used to assess the association between BP levels, BPV, and clinical outcomes. Results: A total of 66 patients were included, of whom 34 had poor outcomes (mRS score, 3-6). Patients with poor outcomes had significantly higher National Institute of Health Stroke Scale scores (4.5 vs. 9, p < 0.001), a larger ICH volume (8 vs. 14.5 mL, p = 0.004), and an increased systolic BP (SBP)-CV (3.2 vs. 4.8, p < 0.001) and diastolic BP (DBP)-CV (3.7 vs. 4.9, p = 0.015). After adjustment for major covariates, multivariate logistic regression analysis revealed that SBP-CV was independently associated with an increased risk of poor in-hospital outcomes [odds ratio (OR) 2.535; 95% confidence interval (CI), 1.211-5.305; p = 0.014]. The receiver operating characteristic area for SBP-CV in predicting poor in-hospital outcome was 0.827 (95% CI, 0.730-0.925; p < 0.001), and the best cutoff point was 3.551 (sensitivity, 82.35%; specificity, 68.75%). Conclusion: A higher beat-to-beat BPV in the first 72 h of admission was associated with unfavorable in-hospital outcomes in patients with ICH. The stabilization of BPV during the acute phase may be a therapeutic target; this could be tested in future clinical trials.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Guo

Reziya

et al. 2020

Front. Aging Neurosci.

View full text Add to dashboard Cite

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“…A total of 53 studies were retrieved for further full-text evaluations, and 46 studies were excluded due to the following reasons: patients with ischemic stroke (n = 27), retrospective design (n = 16), and review or meta-analysis (n = 3). After detailed evaluations, seven prospective studies were selected for the final quantitative metaanalysis (30)(31)(32)(33)(34)(35)(36). No new eligible study was detected by manually searching the reference lists of retrieved studies.…”

Section: Literature Searchmentioning

confidence: 99%

Prognostic Value of Blood Pressure Variability for Patients With Acute or Subacute Intracerebral Hemorrhage: A Meta-Analysis of Prospective Studies

2021

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The results on the role of systolic blood pressure (SBP) variability in the functional outcome for patients with intracerebral hemorrhage (ICH) have been inconsistent. Hence, this meta-analysis of prospective studies was conducted to assess the association between SBP variability and poor outcomes in patients with acute or subacute ICH. PubMed, Embase, and the Cochrane Library were electronically searched for eligible studies from their inception to July 2020. The role of SBP variability assessed using standard deviation (SD), coefficient of variation (CV), successive variation (SV), average real variability (ARV), and residual standard deviation (RSD) in the risk of poor functional outcomes were assessed using odds ratio (OR) with 95% confidence interval (CI) through the random-effects model. Seven prospective studies involving 5,201 patients with ICH were selected for the final meta-analysis. Increased SBP variability was associated with an increased risk of poor functional outcomes, regardless of its assessment using SD (OR: 1.38; 95% CI: 1.14–1.68; P = 0.001), CV (OR: 1.98; 95% CI: 1.13–3.47; P = 0.017), SV (OR: 1.30; 95% CI: 1.08–1.58; P = 0.006), ARV (OR: 1.13; 95% CI: 1.03–1.24; P = 0.010), or RSD (OR: 1.22; 95% CI: 1.00–1.50; P = 0.049). Moreover, the role of SBP variability in the risk of poor functional outcomes for patients with ICH was affected by country, study design, mean age, stroke type, outcome definition, and study quality. This study indicated that SBP variability was a predictor of poor outcomes for patients with ICH.

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“…A post hoc analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH2) trial evaluated 1000 patients with ICH presenting within 4.5 hours with a SBP greater than 180 mm Hg . The trial evaluated intensive BP lowering (110‐139 mm Hg) as compared to standard treatment (140‐180 mm Hg) and given a pre‐specified protocol of antihypertensive agents, including continuous infusion of nicardipine for the first 24 hours.…”

Section: Data Surrounding Blood Pressure Variabilitymentioning

confidence: 99%

Blood pressure variability in the management of hypertensive emergency: A narrative review

Cucci

Benken

2019

J of Clinical Hypertension

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Hypertensive emergencies (HTNe) primarily focus on decreasing the blood pressure to specific targets. However, there are emerging data surrounding the potential clinical effects of blood pressure variability (BPV) in patients with HTNe. This narrative review highlights the various definitions of BPV, the emerging role of BPV, and the clinical data surrounding BPV in the HTNe setting. Clinical studies were obtained from a PubMed search through October 2018 utilizing PICO methodology. Original research articles, systematic reviews, and meta‐analyses were considered for inclusion. Articles were selected for inclusion based on the relevancy of the article investigating BPV in the HTNe setting. There is currently no accepted standard to express BPV in the acute care setting of HTNe, and various parameters have been reported. There are very limited data regarding BPV outside of the neurologic HTNe setting. In the acute treatment phase of neurologic HTNe, BPV is consistently associated with increased risk of unfavorable outcomes. In the HTNe setting, continuous infusion of calcium channel blockers may optimize BPV compared to other agents. Based on current data, BPV should be investigated in a prospective systemic fashion. Efforts should be taken to ensure that BPV is minimized in the acute phase of HTNe, especially for those patients with intracranial hemorrhage. This reduced BPV is associated with improved favorable outcomes, but further study investigating specific pharmacologic agents is needed.

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Increased Blood Pressure Variability Contributes to Worse Outcome After Intracerebral Hemorrhage

Cited by 40 publications

References 7 publications

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

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

Prognostic Value of Blood Pressure Variability for Patients With Acute or Subacute Intracerebral Hemorrhage: A Meta-Analysis of Prospective Studies

Blood pressure variability in the management of hypertensive emergency: A narrative review

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