NYMC Faculty Publications

The Magnitude of Blood Pressure Reduction in Intracerebral Hemorrhage Is Associated With In-Hospital Outcomes

Author Type(s)

Faculty

Journal Title

Neurology

First Page

5115

Document Type

Article

Publication Date

4-13-2021

Department

Neurology

Abstract

Objective:

We aimed to determine the prognostic significance of early magnitude of systolic blood pressure (SBP) reduction (M-SPB-R) in the first 24 hours after intracerebral hemorrhage (ICH).

Background:

Early SBP reduction may improve the outcome after ICH. However, there has been a limited assessment of M-SPB-R as opposed to target SBP on outcomes in ICH.

Design/Methods:

We collected 10 years (2008–2017) of ICH data from two hospital systems. Unsupervised functional principal components analysis (FPCA) was used to characterize the effect of M-SPB-R on the primary outcome defined as discharge modified Rankin scale (mRS) of 0–2, 3–4, and 5–6 defined as good, poor, and severe, respectively. Ordinal logistic regression models adjusted for baseline SBP and ICH volume were used to determine the prognostic significance of M-SPB-R.

Results:

The 757 patients included in the study were 65±23 years old, 56% were men, with a mean Glasgow coma scale of 14 (IQR). FPCA revealed that an increase in M-SPB-R (per 10 mmHg) was significantly associated with unfavorable outcome defined as mRS>2 (adjusted-OR=1.134; 95% CI: 1.044–1.233, P=0.003). Compared with M-SPB-R <20 mmHg, worse outcomes were observed for M-SPB-R= 40–60 mmHg (adjusted-OR=1.940, 95%CI: 1.129–3.353, P=0.017) and >60mmHg, (adjusted-OR=1.965, 95%CI: 1.011–3.846, P=0.047). Furthermore, the association of M-SPB-R and the outcome varied according to initial hematoma volume. Smaller M-SPB-R was associated with good outcome (mRS 0–2) in small (<7.42 mL) and medium-size (≥7.42 and <30.47 mL) hematomas. In contrast, while the likelihood of good outcome was low in those with large hematomas (≥30.47 mL), smaller M-SPB-R was associated with a decreasing probability of severe (mRS 5–6) outcome.

Conclusions:

Early M-SPB-R is associated with in-hospital outcomes in ICH. This association varies with initial hematoma volume. Early SBP reduction should consider both target levels and M-SPB-R goals vis-à-vis hematoma volume.

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