Simona Lattanzi1, Claudia Cagnetti2, Leandro Provinciali2, Mauro Silvestrini2. 1. Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy. Electronic address: alfierelattanzisimona@gmail.com. 2. Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
Abstract
BACKGROUND: The aim of this study was to evaluate whether fluctuations of blood pressure (BP) levels occurring in the acute stage of spontaneous intracerebral hemorrhage (ICH) affect the 3-month clinical outcome. METHODS: We retrospectively identified consecutive patients hospitalized for acute spontaneous ICH. BP measurements over the first 72 hours from the onset of symptoms were recorded, and standard deviation (SD), coefficient of variation (CV), and maximum-minimum difference (max-min) were determined to characterize both systolic and diastolic BP variability (BPV). The measure of outcome was the 3-month functional status assessed by the modified Rankin Scale following a baseline severity-adjusted analysis. RESULTS: Among the 138 enrolled patients with ICH, 67 (48.6%) were classified as having a poor 3-month functional recovery. A dose-response relationship with poor outcome was found for each measure of systolic BPV--adjusted odds ratios (ORs) for the highest thirds of SD 7.95 (95% confidence interval [CI], 2.88-21.90), CV 7.74 (95% CI, 2.88-20.80), and max-min 8.36 (95% CI, 2.72-25.62; P < .001). The strength of association with diastolic BPV turned out to be weaker and significant only for the higher values (adjusted ORs for the highest thirds of SD 6.74 [95% CI, 2.52-18.04], CV 4.57 [95% CI, 1.77-11.81], and max-min 4.34 [95% CI, 1.72-10.93]). CONCLUSIONS: In patients with acute ICH, BPV was a strong predictor of the 3-month clinical outcome and may represent a still neglected potential therapeutic target.
BACKGROUND: The aim of this study was to evaluate whether fluctuations of blood pressure (BP) levels occurring in the acute stage of spontaneous intracerebral hemorrhage (ICH) affect the 3-month clinical outcome. METHODS: We retrospectively identified consecutive patients hospitalized for acute spontaneous ICH. BP measurements over the first 72 hours from the onset of symptoms were recorded, and standard deviation (SD), coefficient of variation (CV), and maximum-minimum difference (max-min) were determined to characterize both systolic and diastolic BP variability (BPV). The measure of outcome was the 3-month functional status assessed by the modified Rankin Scale following a baseline severity-adjusted analysis. RESULTS: Among the 138 enrolled patients with ICH, 67 (48.6%) were classified as having a poor 3-month functional recovery. A dose-response relationship with poor outcome was found for each measure of systolic BPV--adjusted odds ratios (ORs) for the highest thirds of SD 7.95 (95% confidence interval [CI], 2.88-21.90), CV 7.74 (95% CI, 2.88-20.80), and max-min 8.36 (95% CI, 2.72-25.62; P < .001). The strength of association with diastolic BPV turned out to be weaker and significant only for the higher values (adjusted ORs for the highest thirds of SD 6.74 [95% CI, 2.52-18.04], CV 4.57 [95% CI, 1.77-11.81], and max-min 4.34 [95% CI, 1.72-10.93]). CONCLUSIONS: In patients with acute ICH, BPV was a strong predictor of the 3-month clinical outcome and may represent a still neglected potential therapeutic target.
Authors: Adnan I Qureshi; Yuko Y Palesch; William G Barsan; Daniel F Hanley; Chung Y Hsu; Renee L Martin; Claudia S Moy; Robert Silbergleit; Thorsten Steiner; Jose I Suarez; Kazunori Toyoda; Yongjun Wang; Haruko Yamamoto; Byung-Woo Yoon Journal: N Engl J Med Date: 2016-06-08 Impact factor: 91.245
Authors: Janelle O Poyant; Philip J Kuper; Kristin C Mara; Ross A Dierkhising; Alejandro A Rabinstein; Eelco F M Wijdicks; Brianne M Ritchie Journal: Neurocrit Care Date: 2019-02 Impact factor: 3.210
Authors: Adnan I Qureshi; Yuko Y Palesch; Lydia D Foster; William G Barsan; Joshua N Goldstein; Daniel F Hanley; Chung Y Hsu; Claudia S Moy; Mushtaq H Qureshi; Robert Silbergleit; Jose I Suarez; Kazunori Toyoda; Haruko Yamamoto Journal: Stroke Date: 2018-05-22 Impact factor: 7.914