Proper timing of control of hypertension and outcome in acute spontaneous intracerebral hemorrhage

Abstract

Objective Hypertension is the commonest cause of acute spontaneous intracerebral hemorrhage (ICH) which is life-threatening with a poor prognosis. The aim of this study is to evaluate the prognosis and blood pressure monitoring and control in patients presented by acute spontaneous ICH. Methods One hundred and fifty patients presented by acute spontaneous ICH were classified according to the modified Rankin Scale (mRS) score after discharge to 70 patients with better outcomes (mRS = 0–2) while 80 patients with poor outcome (mRS = 3–6). Independent factors that were significantly related to prognosis were assessed by multivariate logistic regression. Spearman’s correlation of the blood pressure monitoring in the acute ICH and the outcome was investigated. Results Systolic blood pressure at the onset of ICH was higher in the unfavorable outcome group (P = 0.009). Diastolic blood pressure 1 h after admission, systolic blood pressure 6 h after admission, and the systolic blood pressure 24 h after admission to hospital were lower in the favorable outcome group (P = 0.005, P = 0.007 and 0.01, respectively). The independent variables related to favorable outcomes were younger age patients (P = 0.004), better level of consciousness at admission to hospital (P = 0.0001), and lower systolic blood pressure 6 h after admission to hospital (P = 0.005), decreased volume of hematoma (P = 0.05), supratentorial ICH (P = 0.02), and absence of intraventricular hemorrhage (P = 0.02). Conclusions Proper control and monitoring of the blood pressure in acute intracerebral hemorrhage must be initiated immediately especially in the first 6 h after hospitalization. Trial registration ClinicalTrials.gov ID: NCT04191863 'Retrospectively registered'

Important Factors to Expect the Outcome After Intracerebral Hemorrhage

“…Low GCS score (<8) was associated with both higher mortality and unfavorable outcomes, which is similar to the findings of other studies from South Asia 21,27,28 . NIHSS score >14 was associated with unfavorable outcomes in our study and has also been reported by Bhatia et al 27 SBP at 24 hours was also a significant predictor of outcome in our cohort of patients, as the mean SBP in patients with unfavorable outcomes was higher than in patients with a favorable outcome [153.1±12.1 vs. 147.9±13.9 mm Hg ( P -value=0.02)], which emphasizes the importance of lowering the mean BP after SICH to improve the outcome, as recommended by studies describing the effect of controlling BP after ICH 29,30 . All risk factors, except the impaired renal function test, equally contributed to the clinical outcome in both groups.…”

“…21,27,28 NIHSS score > 14 was associated with unfavorable outcomes in our study and has also been reported by Bhatia et al 27 SBP at 24 hours was also a significant predictor of outcome in our cohort of patients, as the mean SBP in patients with unfavorable outcomes was higher than in patients with a favorable outcome [153.1 12.1 vs. 147.9 13.9 mm Hg (P-value = 0.02)], which emphasizes the importance of lowering the mean BP after SICH to improve the outcome, as recommended by studies describing the effect of controlling BP after ICH. 29,30 All risk factors, except the impaired renal function test, equally contributed to the clinical outcome in both groups. A low estimated glomerular filtration rate may indicate acute renal injury or chronic kidney disease, which has been mentioned in previous studies to be associated with poor outcomes and mortality 1 year after ICH.…”

Tissue Compliance and Intracranial Pressure Responses to Large Intracerebral Hemorrhage in Young and Aged Spontaneously Hypertensive Rats

“…Though further investigation of these hypotheses is required, taken together, our evidence indicates that hypertensive aging is associated with worse ICH outcomes in this model, as observed clinically. 44,45 Regardless of strain and age, we observed widespread tissue compliance occurring in all ICH groups in our study. Indeed, this tissue compliance, estimated from contralateral hemisphere volume, accommodates at least 35.3 μL (pooled estimate with 95% CI, 17.7-52.9 μL) of mass effect, and this does not include the compliance response within intact regions of the affected ipsilateral hemisphere.…”

Association of baseline hematoma and edema volumes with one-year outcome and long-term survival after spontaneous intracerebral hemorrhage: A community-based inception cohort study

“…We prespecified the covariables used for adjustment in our multivariable analyses using known independent predictors of 30-day outcome after ICH, described by the ICH score which have been robustly established and validated. 3 , 34 Other variables, such as systolic blood pressure, 21 , 35 and blood glucose at initial medical assessment, as well as antithrombotic medication usage 36 , 37 and diabetes mellitus, 38 have been associated with various outcomes after ICH. However, these associations vary between reports or have not been shown to predict outcome independent of the ICH score components and were therefore not included in our multivariable analysis.…”