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

Liu, Weidong; Zhuang, Xun; Zhang, Liyong

doi:10.3389/fneur.2021.606594

Cited by 8 publications

(7 citation statements)

References 62 publications

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“…232 This association between increased BP variability and poor outcomes has been seen in multiple analyses. 233–236 Similarly, a retrospective cohort study of ICH patients found that greater magnitude of SBP reduction (>40 mm Hg) was associated with worse outcomes. 237 In a pooled meta-analysis of individual patient data from 16 trials, BP reduction was not associated with improved functional outcomes but was associated with reduced HE.…”

Section: Treatmentmentioning

confidence: 99%

Cerebral Hemorrhage: Pathophysiology, Treatment, and Future Directions

Magid-Bernstein

Girard

Polster

et al. 2022

Circulation Research

242

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Intracerebral hemorrhage (ICH) is a devastating form of stroke with high morbidity and mortality. This review article focuses on the epidemiology, cause, mechanisms of injury, current treatment strategies, and future research directions of ICH. Incidence of hemorrhagic stroke has increased worldwide over the past 40 years, with shifts in the cause over time as hypertension management has improved and anticoagulant use has increased. Preclinical and clinical trials have elucidated the underlying ICH cause and mechanisms of injury from ICH including the complex interaction between edema, inflammation, iron-induced injury, and oxidative stress. Several trials have investigated optimal medical and surgical management of ICH without clear improvement in survival and functional outcomes. Ongoing research into novel approaches for ICH management provide hope for reducing the devastating effect of this disease in the future. Areas of promise in ICH therapy include prognostic biomarkers and primary prevention based on disease pathobiology, ultra-early hemostatic therapy, minimally invasive surgery, and perihematomal protection against inflammatory brain injury.

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Section: Treatmentmentioning

confidence: 99%

Cerebral Hemorrhage: Pathophysiology, Treatment, and Future Directions

Magid-Bernstein

Girard

Polster

et al. 2022

Circulation Research

242

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“…Larger blood pressure variability [61] and elevated homocysteine levels [62,63] have been found to increase the risk of CSVD. Similarly, the above two factors are risk factors for adverse functional outcome and low survival in patients with ICH [64,65]. In the great majority of studies, blood pressure variability and homocysteine levels were not considered when investigating the independent association between CSVD and prognosis.…”

Section: Discussionmentioning

confidence: 99%

Cerebral small vessel disease and prognosis in intracerebral haemorrhage: A systematic review and meta‐analysis of cohort studies

Cheng

Zhang

Zhan

et al. 2022

Euro J of Neurology

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Background and purpose The aim was to investigate whether cerebral small vessel disease (CSVD) markers and the total CSVD burden are associated with functional outcome, mortality, stroke recurrence and haematoma expansion in patients with spontaneous intracerebral haemorrhage (ICH). Methods Following a previously registered protocol (PROSPERO protocol: CRD42021287743), PubMed, Web of Science and Embase were systematically searched to identify relevant literature up to November 2021. Cohort studies that examined the association between CSVD markers (white matter hyperintensity [WMH], lacune, enlarged perivascular space [EPVS], cerebral microbleed [CMB] and brain atrophy) or CSVD burden and prognosis in patients with ICH were included. The pooled estimates were calculated using random effects models. Results Forty‐one studies with 19,752 ICH patients were pooled in the meta‐analysis. WMH (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.32–1.70), lacune (OR = 1.32, 95% CI 1.18–1.49), CMB (OR = 2.60, 95% CI 1.13–5.97) and brain atrophy (OR = 2.22, 95% CI 1.48–3.31) were associated with worse functional outcome. CSVD markers concerning increased risk of mortality were WMH (OR = 1.57, 95% CI 1.38–1.79) and brain atrophy (OR = 1.84, 95% CI 1.11–3.04), and markers concerning increased risk of stroke recurrence were WMH (OR = 1.62, 95% CI 1.28–2.04) and lacune (OR = 3.00, 95% CI 1.68–5.37). Enlarged perivascular space was not related to prognosis. There was a lack of association between CSVD markers and haematoma expansion. CSVD burden increased the risk of worse functional outcome, mortality and stroke recurrence by 57%, 150% and 44%, respectively. Conclusions In patients with spontaneous ICH, WMH, lacune, CMB, brain atrophy and the total CSVD burden are associated with substantially increased risk of worse functional outcome, mortality or stroke recurrence.

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“…It is suggested that smooth and sustained control of blood pressure is needed in the ultra early stage. Liu W. et al (2021) included 7 randomized controlled prospective studies with 5,201 participants in their meta-analysis. Increased SBP variability was associated with an increased risk of poor functional outcomes: The results are SD (OR: 1.38, P = 0.001), CV (OR: 1.98, P = 0.017), SV (OR: 1.30, P = 0.006), and the effect of SBP variability on the risk of poor functional outcomes in ICH patients was affected by country, study design, mean age, stroke type, outcome definition, and study quality.…”

Section: Discussionmentioning

confidence: 99%

The effect of blood pressure variability on the prognosis of patients with acute cerebral hemorrhage: Possible mechanism

Sun

Jv²,

Mo³

et al. 2022

Front. Neurosci.

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BackgroundAntihypertensive therapy in the acute phase of intracerebral hemorrhage (ICH) can reduce hematoma expansion. Numerous studies have demonstrated that blood pressure variability secondary to antihypertensive therapy has adverse effects on neurological outcomes, but the conclusions are diverse, and the mechanism of this occurrence is unknown. The aim of this research was to analyze the impact of blood pressure variability after antihypertensive treatment on the prognosis of patients with acute ICH, along with the possible mechanism.Materials and methodsA total of 120 patients within 20 h of onset of ICH were divided into a good prognosis group (mRS ≤ 2 points) and a poor prognosis group (mRS ≥ 3 points) according to their 90-day mRS scores. The basic patient information, NIHSS score, GCS score, mRS score at 90 days after admission, head CT examination at admission and 24 h and CTP examination at 24 h were collected from some patients. The blood pressure values of patients were collected within 24 h, and multiple blood pressure variation (BPV) parameters within 1 and 24 h were calculated.Results(1) After excluding confounding factors such as age, whether the hematoma ruptured into the ventricle, confounding signs, amount of bleeding, edema around the hematoma, NIHSS on admission, operation or non-operation, and 24-h hematoma increment, the fourth quartile systolic blood pressure (SBP) maximum and minimum difference within 1 h [OR: 5.069, CI (1.036–24.813) P = 0.045] and coefficient of continuous variation (SV) within 24 h [OR: 2.912 CI (1.818–71.728) P = 0.009] were still independent factors affecting the 90-day mRS in ICH patients. (2) There was a negative correlation between SBP SV and CBF in terms of the difference between the contralateral side and the perihematomal region at 24 h (Rs = −0.692, P = 0.013).ConclusionBlood pressure variability after antihypertensive therapy in acute ICH is one of the influencing factors for 90-day mRS in patients. A 1-h dramatic drop in SBP and 24-h SBP SV may affect the long-term prognosis of patients by reducing whole cerebral perfusion.

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

Cited by 8 publications

References 62 publications

Cerebral Hemorrhage: Pathophysiology, Treatment, and Future Directions

Cerebral Hemorrhage: Pathophysiology, Treatment, and Future Directions

Cerebral small vessel disease and prognosis in intracerebral haemorrhage: A systematic review and meta‐analysis of cohort studies

The effect of blood pressure variability on the prognosis of patients with acute cerebral hemorrhage: Possible mechanism

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