Background and Purpose: Recently published trials--INTERACT 2, SAMURAI--have shown that early aggressive systolic blood pressure (SBP) management in patients presenting with intracerebral hemorrhage (ICH) may improve functional outcome and prevent early neurological deterioration, respectively. Additionally, post-hoc analyses and growing literature have demonstrated the importance of SBP variability toward clinical outcome. We sought to evaluate the role of blood pressure variability within the hyperacute phase (defined as the first 24 hours) after hospitalization for ICH and its role in short-term clinical outcome.
Material and Methods: We retrospectively analyzed consecutive patients presenting with ICH at a tertiary level stroke center. Study inclusion criteria included adult age, ICH etiology as either hypertensive or amyloid angiopathy, and image confirmation of ICH. All patients with ICH were initially admitted to the intensive care unit; hourly blood pressure measurements within the first twelve hours were recorded. Blood pressure variability was calculated by taking the standard deviation of these initial hourly measurements.
Results: 90 patients fulfilled study inclusion criteria. Independent samples T-test showed the following: (1) maximum systolic blood pressure (maxSBP) were higher in those with poor outcome (197 ±29 mmHg) and good outcome (183 ±28 mmHg) (p=0.024) and (2) systolic blood pressure variation (SBPsd) was greater in those with poor outcome (24 ±9 mmHg) than good outcome (20 ±8 mmHg) (p=0.021). Multivariable regression analysis, adjusted for age, vascular risk factors (hypertension, diabetes, coronary artery disease, congestive heart failure, alcohol abuse, smoking), and clinical condition at admission (admission NIH stroke scale score and ICH score) showed that SBPsd remained an independent predictor of poor clinical outcome (p=0.043) and showed that for every 1 mmHg increase in SBP variability, the likelihood of poor clinical outcome was independently increased by 18% [95%CI (0.01-0.39)].
Conclusions: Systolic blood pressure variability in the hyperacute phase could independently account for poor clinical outcomes in patients with intracerebral hemorrhage.