Twenty-four-hour blood pressure variability plays a detrimental role in the neurological outcome of hemorrhagic stroke

Zhang, Huanxin; Fan, Qun-Xiong; Xue, Shi-Zhen; Zhang, Min; Ji-xian, Zhao

doi:10.1177/0300060518760463

Cited by 13 publications

(10 citation statements)

References 36 publications

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“…The multivariate logistic regression analysis was accomplished for the proper time for control of blood pressure showed that diastolic blood pressure 1 h after admission, systolic BP 6 h after admission, and systolic blood pressure 24 h after admission were accompanied by the favorable outcome. Similarly, Huan-Xin et al 2018 concluded that high systolic or diastolic blood pressure during 24 h ICH onset is accompanied by the 90-day neurological outcome, and the first 24-h BP plays a critical role in the neurological outcome of hemorrhagic stroke [37]. Also, the second Intensive Blood Pressure Reduction in the Acute Cerebral Hemorrhage Trial (INTERACT2) assessed the predictive value of BP variability in outcomes for ICH patients (within 6 h after symptom onset) targeting BP levels to lower than 140 mmHg.…”

Section: Discussionmentioning

confidence: 99%

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

Esmael

Fathi

Abdelbadie

et al. 2020

Egypt J Neurol Psychiatry Neurosurg

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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'

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Section: Discussionmentioning

confidence: 99%

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

Esmael

Fathi

Abdelbadie

et al. 2020

Egypt J Neurol Psychiatry Neurosurg

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“…Conventional craniotomy for hematoma removal plus bone flap decompression is commonly used for patients with large volume hematoma. Previous studies demonstrated that it could reduce the intracranial pressure, prevent and reduce blood cell decomposition after bleeding, increase the survival rate, and improve the quality of life [ 29 , 30 ]. However, iatrogenic injuries of conventional open surgery remain serious.…”

Section: Discussionmentioning

confidence: 99%

Intracerebral hemorrhage with tentorial herniation: Conventional open surgery or emergency stereotactic craniopuncture aspiration surgery?

Shi

Zou

Jiang

et al. 2021

Translational Neuroscience

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Background To observe the therapeutic effect of conventional decompressive craniectomy with hematoma evacuation and frame-based stereotactic minimally invasive surgery (MIS) for supratentorial intracranial hematoma with herniation. Methods One hundred forty-nine patients with hypertensive ICH complicated with tentorial herniation were reviewed and analyzed in the present study. The intracranial hematoma was evacuated by emergency surgery within 6 h after admission. According to the authorized representatives’ wishes and consent, 74 of the 149 patients were treated by conventional decompressive craniectomy followed by hematoma removal, defined as the CDC group, and the remaining 75 patients underwent frame-based stereotactic MIS for ICH evacuation, defined as the MIS group. The intervals between the admission to surgery, the duration of surgery, the amount of iatrogenic bleeding, the occurrence of postoperative rebleeding, and the recovery of neurological functions were compared between the two groups. All patients were followed up for 3 months. Secondary epilepsy, survival in a vegetative state, severe pulmonary complications, mortality, and activities of daily living (ADL) classification were also recorded and compared. Results The interval between admission and surgery, the duration of surgery, and intraoperative blood loss in the MIS group were significantly decreased compared to the CDC group. The mortality rate, the rate of rebleeding, prevalence of vegetative state, and severe pulmonary complications in the MIS group were remarkably decreased compared to the CDC group. In the MIS group, the survivors’ (ADL) grade also showed advantages. Conclusions In the surgical treatment of hypertensive ICH complicated with tentorial herniation, frame-based stereotactic MIS for ICH showed advantages compared to conventional open surgery.

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“…Manning et al's 26 systematic review reflected similar results, with greater systolic BPV following IVT for AIS being associated with poor long‐term functional outcome. Similarly, BPV‐specific cohort studies and post‐hoc analysis of previous randomized controlled trials have shown that short‐term BPV in patients with intracerebral hemorrhage is strongly associated with hematoma expansion, neurological deterioration, and poor functional outcome at 3 months 27‐29 …”

Section: Discussionmentioning

confidence: 95%

Systolic blood pressure variability following endovascular thrombectomy and clinical outcome in acute ischemic stroke: A meta‐analysis

et al. 2021

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Blood pressure variability (BPV) has been linked with the outcome of acute ischemic stroke (AIS) after endovascular thrombectomy (EVT). However, the association of the stroke outcome with specific short‐term BPV parameters is unclear. We did a systematic literature search for studies published from January 2010 to September 2020. Eligibility criteria included studies with (1) AIS patients treated with EVT with or without thrombolysis; and (2) analysis of the association between short‐term systolic BPV parameter and clinical outcomes. Systolic BPV parameters included standard deviation (SD), coefficient of Variation (CoV), successive Variation (SV), and Variation independent of mean. A total of 11 studies were meta‐analyzed, comprising 3520 patients who underwent EVT. Lower odds of achieving good functional outcome at 3 months; that is, modified Rankin Scale (mRS) score ≤2 was associated with SD (OR, 0.854; p = .02), CoV (OR, 0.572; p = .04), SV (OR 0.41; p = .00) of systolic blood pressure (SBP). Likewise, higher odds of one‐point increase in mRS score was associated with SD (OR 1.42; p = .03), CoV (OR 1.464; p = .00) and SV (OR 2.605; p = .00) of SBP. However, high BPV was not associated with symptomatic intracranial hemorrhage and all‐cause mortality at 90 days. The association of BPV and early neurological deterioration was inconclusive. Based on the available studies, short‐term systolic BPV is indicative of the clinical outcome of patients following EVT in AIS. Further research should focus on personalized blood pressure management strategies, rather than a one‐size‐fits‐all approach.

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Twenty-four-hour blood pressure variability plays a detrimental role in the neurological outcome of hemorrhagic stroke

Cited by 13 publications

References 36 publications

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

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

Intracerebral hemorrhage with tentorial herniation: Conventional open surgery or emergency stereotactic craniopuncture aspiration surgery?

Systolic blood pressure variability following endovascular thrombectomy and clinical outcome in acute ischemic stroke: A meta‐analysis

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