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

Abstract

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.

Time course of beat-to-beat blood pressure variability and outcome in patients with spontaneous intracerebral haemorrhage

“…Sykora et al [11,30] found that 72-h beat-to-beat mean arterial pressure variability was related to relative oedema and 10-day outcome in a univariate analysis; however, the result was not duplicated in a stepwise multivariate linear regression analysis. We previously demonstrated in an earlier report from acute spontaneous supratentorial ICH patients that beat-to-beat BPV derived by SBP was associated with a 2.5fold increase in the risk of poor in-hospital outcomes for every unit of beat-to-beat BPV increase, independent of admission and mean beat-to-beat blood pressure level [31]. The present study further indicated that beat-to-beat BPV, measured 1-2 days after ICH onset, calculated from either SBP or DBP, was associated with unfavourable functional outcomes at 3 months, independent of mean blood pressure.…”

Association between within-visit blood pressure variability, stroke, coronary heart disease, and cardiovascular mortality

“…Previous studies have shown an association between an excessive drop in nocturnal blood pressure and silent cerebrovascular lesions [24,25]. The explanation for this could be pre-existing cerebral ischaemia that could lead to both altered central autonomic control of blood pressure [26,27] and an increased risk of stroke. Furthermore, BP variability is also known to associate with pro-inflammatory cytokine production, hyperglycaemia, and increased blood-brain-barrier permeability [28][29][30][31], all of which can contribute to an increased risk of stroke.…”

A Longitudinal Research on the Distribution and Prognosis of Intracerebral Hemorrhage During the COVID-19 Pandemic

“…As vaccination becomes more widespread, gradual deregulation of traffic restrictions would effectively improve the prognosis of patients with stroke. Simultaneously, for the high proportion of hypertensive cerebral hemorrhage cases, strengthening the prevention, and control of hypertension before and after ICH is also important ( 28 , 29 ).…”