Long‐Term Blood Pressure Variability and Major Adverse Cardiovascular and Cerebrovascular Events After Intracerebral Hemorrhage

Castello, Juan Pablo; Teo, Kay‐Cheong; Abramson, Jessica R; Keins, Sophia; Takahashi, Courtney; Leung, Ian Y.H.; Leung, William C.Y.; Wang, Yujie; Kourkoulis, Christina; Myserlis, Evangelos Pavlos; Warren, Andrew; Henry, Jonathan J.; Chan, Koon‐Ho; Cheung, Raymond T.F.; Ho, Shu‐Leong; Gurol, M. Edip; Viswanathan, Anand; Greenberg, Steven M.; Anderson, Chris; Lau, Kui Kai; Rosand, Jonathan; Biffi, Alessandro

doi:10.1161/jaha.121.024158

Cited by 9 publications

(19 citation statements)

References 31 publications

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Section: Discussionmentioning

confidence: 99%

“…However, the observed association raises concern for inadequate intensification of antihypertensive medications in this group of ICH survivors, leading to increased ICH recurrence, small vessel disease outcomes, and major cardiovascular events which we have associated with elevated follow-up BP in our cohort. 7,8,16 There have been numerous studies investigating the role of clinical, social, and other determinants of resistant hypertension or uncontrolled BP in the general population. [19][20][21][22] Among the factors that have been reported are older age, male sex, black race, diabetes mellitus, hyperlipidemia, chronic kidney disease, obesity or higher body mass index (BMI), coronary artery disease, atrial fibrillation, medical history of cerebrovascular accident or transient ischemic attack, peripheral vascular disease, and lower educational attainment and income.…”

Section: Discussionmentioning

confidence: 99%

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Lobar intracerebral hemorrhage and risk of subsequent uncontrolled blood pressure

Myserlis

Mayerhofer

Abramson

et al. 2022

European Stroke Journal

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Background: Uncontrolled blood pressure (BP) in intracerebral hemorrhage (ICH) survivors is common and associated with adverse clinical outcomes. We investigated whether characteristics of the ICH itself were associated with uncontrolled BP at follow-up. Methods: Subjects were consecutive patients aged ⩾18 years with primary ICH enrolled in the prospective longitudinal ICH study at Massachusetts General Hospital between 1994 and 2015. We assessed the prevalence of uncontrolled BP (mean BP ⩾140/90 mmHg) 6 months after index event. We used multivariable logistic regression models to assess the effect of hematoma location, volume, and event year on uncontrolled BP. Results: Among 1492 survivors, ICH was lobar in 624 (42%), deep in 749 (50%), cerebellar in 119 (8%). Lobar ICH location was associated with increased risk for uncontrolled BP after 6 months (OR 1.35; 95% CI [1.08–1.69]). On average, lobar ICH survivors were treated with fewer antihypertensive drugs compared to the rest of the cohort: 2.1 ± 1.1 vs 2.5 ± 1.2 ( p < 0.001) at baseline and 1.8 ± 1.2 vs. 2.4 ± 1.2 ( p < 0.001) after 6 months follow-up. After adjustment for the number of antihypertensive drugs prescribed, the association of lobar ICH location with risk of uncontrolled BP was eliminated. Conclusions: ICH survivors with lobar hemorrhage were more likely to have uncontrolled BP after 6 months follow-up. This appears to be a result of being prescribed fewer antihypertensive medications. Future treatment strategies should focus on aggressive BP control after ICH independent of hemorrhage location.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lobar intracerebral hemorrhage and risk of subsequent uncontrolled blood pressure

Myserlis

Mayerhofer

Abramson

et al. 2022

European Stroke Journal

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“…BPV has been repeatedly linked with adverse outcomes independent of absolute BP control [ 9 , 32 , 33 ]. For example, high systolic BPV is associated with poor outcomes of acute stroke [ 10 , 11 ], hastened progression of cerebral small vessel disease (i.e., white matter hyperintensities, lacunae of presumed vascular origin, cerebral microbleeds, and enlarged perivascular spaces) [ 34 , 35 ], increased risk of cardiovascular-related disease and death [ 9 , 13 , 36 , 37 ], and progression of chronic kidney disease [ 14 , 38 ]. Long-term BPV (clinic visit-to-visit variability) is also associated with rapid onset and development of mild cognitive impairment and dementia [ 39 ], despite excellent BP control [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Association of Blood Pressure Variability with Delirium in Patients with Critical Illness

et al. 2022

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Background The objective was to examine the association of blood pressure variability (BPV) during the first 24 h after intensive care unit admission with the likelihood of delirium and depressed alertness without delirium (“depressed alertness”). Methods This retrospective, observational, cohort study included all consecutive adult patients admitted to an intensive care unit at Mayo Clinic, Rochester, Minnesota, from July 1, 2004, through October 31, 2015. The primary outcomes were delirium and delirium-free days, and the secondary outcomes included depressed alertness and depressed alertness-free days. Logistic regression was performed to determine the association of BPV with delirium and depressed alertness. Proportional odds regression was used to assess the association of BPV with delirium-free days and depressed alertness-free days. Results Among 66,549 intensive care unit admissions, delirium was documented in 20.2% and depressed alertness was documented in 24.4%. Preserved cognition was documented in 55.4% of intensive care unit admissions. Increased systolic and diastolic BPV was associated with an increased odds of delirium and depressed alertness. The magnitude of the association per 5-mm Hg increase in systolic average real variability (the average of absolute value of changes between consecutive systolic blood pressure readings) was greater for delirium (odds ratio 1.34; 95% confidence interval 1.29–1.40; P < 0.001) than for depressed alertness (odds ratio 1.06; 95% confidence interval 1.02–1.10; P = 0.004). Increased systolic and diastolic BPV was associated with fewer delirium-free days but not with depressed alertness-free days. Conclusions BPV in the first 24 h after intensive care unit admission is associated with an increased likelihood of delirium and fewer delirium-free days.

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“…Systolic and diastolic BP measurements were calibrated on 10 mm Hg increases, and entered in mixed effects models as time-varying exposures. 19 Educational level was dichotomized using as cutoff ≥ 12 years of education. Lobar versus nonlobar ICH location was analyzed as a dichotomous variable.…”

Section: Methodsmentioning

confidence: 99%

Association of Depression Onset and Treatment With Blood Pressure Control After Intracerebral Hemorrhage

Keins

Abramson

Mallick

et al. 2023

Stroke

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Background: Blood pressure (BP) control represents a crucial intervention to improve long-term outcomes following spontaneous intracerebral hemorrhage (ICH). However, fewer than half of ICH survivors achieve target treatment goals. ICH survivors are also at very high risk for poststroke depression, which may contribute to inadequate BP control. We, therefore, sought to determine whether depressive symptoms after ICH are associated with inadequate BP control. We also investigated whether associations between depression after ICH and BP measurements were mediated by treatment with selective serotonin reuptake inhibitors or norepinephrine-serotonin reuptake inhibitors antidepressants. Methods: We leveraged data from a single-center longitudinal study of ICH conducted at Massachusetts General Hospital (Boston, MA) between 2006 and 2018. We collected data from semiautomated review of electronic health records, baseline and follow-up interviews, and computed tomography imaging. Information on BP measurements, depression diagnoses, antidepressants medication use, and medical visits were collected longitudinally and analyzed using mixed effects models. Primary outcomes included systolic and diastolic BP measurements during long-term follow-up after ICH. Results: We included 1243 consecutive ICH patients without pre-stroke depression history. Of these, 721 (58%) were diagnosed with incident depression over a median follow-up time of 52.8 months (interquartile range, 42.1–60.5). Depression onset was associated with subsequent increase in systolic (+8.3 mm Hg, SE, 2.4 mm Hg, P =0.012) and diastolic (+4.4 mm Hg, SE, 1.2 mm Hg) BP measurements. Resolution of depressive symptoms was associated with subsequent decrease in systolic (−5.9 mm Hg, SE, 1.4 mm Hg, P =0.031) and diastolic (−3.4 mm Hg, SE, 1.1 mm Hg, P =0.041) BP measurements. We also found associations between higher systolic BP measurements and use of selective serotonin reuptake inhibitor and noradrenaline-serotonin reuptake inhibitor antidepressants, independent of whether depression symptoms were active or not (all P <0.05). Conclusions: ICH survivors displayed increasing BP values after receiving a diagnosis of depression, followed by decreasing values among those experiencing resolution of depressive symptoms. Use of selective serotonin reuptake inhibitor and noradrenaline-serotonin reuptake inhibitor antidepressants was independently associated with higher systolic BP measurements. Clinicians ought to closely monitor BP for ICH survivors being treated for depression, especially using selective serotonin reuptake inhibitor and noradrenaline-serotonin reuptake inhibitor. Future studies will also be required to investigate the mechanisms underlying these associations.

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Long‐Term Blood Pressure Variability and Major Adverse Cardiovascular and Cerebrovascular Events After Intracerebral Hemorrhage

Cited by 9 publications

References 31 publications

Lobar intracerebral hemorrhage and risk of subsequent uncontrolled blood pressure

Lobar intracerebral hemorrhage and risk of subsequent uncontrolled blood pressure

Association of Blood Pressure Variability with Delirium in Patients with Critical Illness

Association of Depression Onset and Treatment With Blood Pressure Control After Intracerebral Hemorrhage

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