812: CLINICAL IMPACT OF BLOOD PRESSURE VARIABILITY WITH NICARDIPINE USE IN INTRACEREBRAL HEMORRHAGE

Objective To quantify in-hospital systolic blood pressure variability among patients with intracerebral hemorrhage, determine the association between high systolic blood pressure variability (HSBPV) and 90-day severe disability or death, and examine the association between pre-hospital factors and HSBPV. Methods Adult, radiologically confirmed, intracerebral hemorrhage patients enrolled in a multi-site cohort were included. Using a semi-automated algorithm, systolic blood pressure values recorded from routine non-invasive systolic blood pressure monitoring in critical and acute care settings were extracted for the duration of hospitalization. Inter and intra-patient systolic blood pressure variability was quantified using generalized estimating equation methods. Modified Poisson and logistic regression models were fit to determine the association between HSBPV and 90-day severe disability or death and between pre-hospital characteristics and HSBPV, respectively. Results A total of 566 patients managed at four certified stroke centers were included. Over 120,000 systolic blood pressure readings were analyzed, and a standard deviation (SD) of 13.0 was parameterized as a cut-off point to categorize HSBPV. Patients with HSBPV had a greater risk of 90-day severe disability or death (relative risk: 1.20, 95% confidence interval: 1.04–1.39), after controlling for age, pre-morbid functional status, and other disease severity measures. Greater likelihood of in-hospital HSBPV was independently observed in elderly, female patients, and in patients with high admission systolic blood pressure. Conclusion Quantification of HSBPV is feasible utilizing routinely collected systolic blood pressure readings, and a singular cut-off parameter for systolic blood pressure variability demonstrated association with 90-day severe disability or death. Elderly, female, and patients with high admission systolic blood pressure may be more likely to demonstrate HSBPV during hospitalization.

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Response by Ziai et al to Letter Regarding Article, “Blood Pressure Variability Predicts Poor In-Hospital Outcome in Spontaneous Intracerebral Hemorrhage”

Stroke ◽

10.1161/strokeaha.119.026859 ◽

2019 ◽

Vol 50 (9) ◽

Cited By ~ 1

Author(s):

Wendy Ziai ◽

Simona Lattanzi ◽

Afshin A. Divani

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Blood Pressure Variability ◽

Spontaneous Intracerebral Hemorrhage ◽

Hospital Outcome

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Blood Pressure Variability after Intravenous Thrombolysis in Acute Stroke Does Not Predict Intracerebral Hemorrhage but Poor Outcome

Cerebrovascular Diseases ◽

10.1159/000334186 ◽

2012 ◽

Vol 33 (2) ◽

pp. 135-140 ◽

Cited By ~ 30

Author(s):

Lars Kellert ◽

Marek Sykora ◽

Christoph Gumbinger ◽

Oliver Herrmann ◽

Peter A. Ringleb

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Acute Stroke ◽

Blood Pressure Variability ◽

Intravenous Thrombolysis ◽

Poor Outcome

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Blood Pressure Variability and Clinical Outcome in Patients with Acute Intracerebral Hemorrhage

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2015.03.014 ◽

2015 ◽

Vol 24 (7) ◽

pp. 1493-1499 ◽

Cited By ~ 52

Author(s):

Simona Lattanzi ◽

Claudia Cagnetti ◽

Leandro Provinciali ◽

Mauro Silvestrini

Keyword(s):

Blood Pressure ◽

Clinical Outcome ◽

Intracerebral Hemorrhage ◽

Blood Pressure Variability ◽

Acute Intracerebral Hemorrhage

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Blood Pressure Variability Predicts Poor In-Hospital Outcome in Spontaneous Intracerebral Hemorrhage

Stroke ◽

10.1161/strokeaha.119.025514 ◽

2019 ◽

Vol 50 (8) ◽

pp. 2023-2029 ◽

Cited By ~ 38

Author(s):

Afshin A. Divani ◽

Xi Liu ◽

Mario Di Napoli ◽

Simona Lattanzi ◽

Wendy Ziai ◽

...

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Blood Pressure Variability ◽

Spontaneous Intracerebral Hemorrhage ◽

Hospital Outcome

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Blood Pressure Variability and Outcome in Patients with Acute Nonlobar Intracerebral Hemorrhage following Intensive Antihypertensive Treatment

Chinese Medical Journal ◽

10.4103/0366-6999.226886 ◽

2018 ◽

Vol 131 (6) ◽

pp. 657-664 ◽

Cited By ~ 4

Author(s):

Jin Pyeong Jeon ◽

Chulho Kim ◽

Sung-Eun Kim

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Blood Pressure Variability ◽

Antihypertensive Treatment

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Abstract P440: Inpatient Blood Pressure Variability is Associated With Mortality and Poor Functional Outcome in Patients With Intracerebral Hemorrhage

Stroke ◽

10.1161/str.52.suppl_1.p440 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Evangelos Pavlos Myserlis ◽

Jessica R Abramson ◽

Haitham Alabsi ◽

Christopher D Anderson ◽

Alessandro Biffi ◽

...

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Blood Pressure Variability ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Poor Functional Outcome ◽

Logistic Regression Models ◽

Established Risk Factor ◽

The Impact

Introduction: Although elevated blood pressure (BP) is an established risk factor for intracerebral hemorrhage (ICH), the impact of acute BP fluctuations on ICH outcomes remains unclear. In this study, we sought to investigate the effect of acute BP variability (BPV) on mortality and functional outcome in ICH survivors. Methods: Subjects were consecutive ICH patients ≥ 18 years with available inpatient BP data, who survived hospitalization. Four measures of systolic BPV were calculated: standard deviation (SD), coefficient of variation (CoV), average real variability (ARV), and successive variation (SV). Our outcomes were (1) death and (2) poor functional outcome, defined as a modified Rankin Score (mRS) of 3-6 in a period between 60-120 days after discharge. We assessed the effect of hyperacute (ICH event-72 hours) and acute/subacute (72 hours-discharge) BPV on outcomes. We constructed Cox proportional hazards and logistic regression models to investigate the associations of BPV (per 10 mmHg increase) with mortality and poor functional outcome, respectively, after adjustment for potential confounders. Results: We included 345 patients, 120 of whom had available mRS data. 151 (43.8%) patients were female and 280 (81.2%) were white; mean age was 71 (±13) years. SBP ARV and SBP SV were the strongest predictors of mortality (HR 2.53-2.91 per 10 mmHg increase), while SBP SD, CoV, and SV were the strongest predictors of poor functional outcome (OR 2.89-5.14 per 10 mmHg increase) (Table) . These associations remained significant when analyzing both hyperacute as well as acute/subacute BPV. Compared to hyperacute BPV, acute/subacute BPV was more strongly associated with both mortality and poor functional outcome. Conclusion: Inpatient blood pressure variability is an important determinant of mortality and poor functional outcome in ICH survivors. Further studies are needed to investigate the role of addressing BPV as a potential target for intervention.

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Abstract TP234: The Effect of Early Treatment with Magnesium on Blood Pressure Variability in Hyperacute Stroke

Stroke ◽

10.1161/str.48.suppl_1.tp234 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Joseph Kim ◽

Jeffrey L Saver ◽

David S Liebeskind ◽

Sidney Starkman ◽

Scott Hamilton ◽

...

Keyword(s):

Blood Pressure ◽

Standard Deviation ◽

Cerebral Ischemia ◽

Intracerebral Hemorrhage ◽

Systolic Blood Pressure ◽

Acute Stroke ◽

Magnesium Sulfate ◽

Blood Pressure Variability ◽

Hyperacute Stroke ◽

Magnesium Treatment

Background: Increased blood pressure (BP) variability has been associated with worse outcomes in acute stroke. Magnesium has been shown to have both vasoactive and cardio-active properties that could potentially attenuate blood pressure variability emergently. Objective: To investigate whether intravenous magnesium sulfate can minimize blood pressure variability in hyperacute stroke. Methods: All patients with a diagnosis of stroke (cerebral ischemia, intracerebral hemorrhage) enrolled in the NIH Field Administration of Stroke Therapy-Magnesium (FAST-MAG) phase 3 trial were included. FAST-MAG was a multicenter, randomized, double-blind, placebo-controlled study looking at whether initiation of magnesium sulfate (20 grams/24 hours) in the prehospital setting of acute stroke would reduce disability. Study agent was initiated prior to hospital arrival < 2 hours from symptom onset. Blood pressure variability was defined as the standard deviation (SD) of systolic blood pressure of all readings obtained by 4 hours after initiation of study agent. BP variability was compared using t-test of the bootstrapped SD between groups. Results: In total, 1,700 patients were included in the study with a median of 6 (IQR 5-6) BP readings, of which 1,245 had cerebral ischemia (CI), 387 had intracerebral hemorrhage (ICH), and 68 had stroke mimics. Of those with CI, 632 received magnesium and 613 placebo; the standard deviation of systolic blood pressure was not significantly different between those who received magnesium and those who did not (14.9mmHg vs. 15.3mmHg, p=0.315). In the ICH population (195 magnesium, 192 placebo), magnesium treatment also did not affect BP variability (22.5mmHg vs. 21.1mmHg, p=0.197). For the overall study group, hyperacute magnesium treatment had no effect on blood pressure variability (16.7mmHg vs. 16.6mmHg, p=.907). Conclusion: Treatment with magnesium did not reduce BP variability in hyperacute stroke.

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