1535: BLOOD PRESSURE VARIABILITY AND OUTCOME IN TRAUMATIC BRAIN INJURY: A PROPENSITY SCORE MATCHING STUDY

Introduction: Arterial calcification is associated with vascular stiffness, which manifests with visit-to-visit blood pressure variability (VVBPV). Although media arterial calcification (MAC) is significantly associated with poor cardiovascular outcomes in kidney patients, the association in kidney transplant (KT) patients is unknown. Hypothesis: We hypothesize that MAC is associated with VVBPV in long-tern post-KT. Methods: Since MAC, which is detected from mammogram (MG) and determined by linear calcified breast arteries, is exclusively medial, female KT patients with ≥1 MG during pre-KT period were included in this study. VVBPV was examined by average successive variability (ASV), which is the average absolute difference between successive BP measured at 4, 12, 24, 36, and 48 weeks post-KT. After balancing patients with and without MAC by using propensity score matching based on age, diabetes, and obesity status, the association between MAC and systolic and diastolic VVBPV (VVSBPV and VVDBPV) at 48 weeks post-KT was tested by multiple linear regression (Figure1A&1B). Results: Of 51 patients, mean age±SD is 54±12 years, 21 had diabetes, and 21 were obese. Mean duration of follow-up was 47±9 years. Among 20 patients with MAC, mean VVSBPV was 20±14 mmHg; whereas, VVSBPV in non-MG group was 14±8 mmHg (mean difference -6± 3.0, p 0.06, 95%CI -12.03, 0.15). Mean VVDBPV in MG and non-MG groups were 12±5 and 11±5.6 mmHg, respectively (mean difference -1±1.6, p 0.41, 95%CI -4.44, 1.86). Laboratory-related bone and mineral metabolism were not different between both groups. On average, MG group had 8 mmHg higher VVSBPV compared to non-MG group (Coef. 3.62, p 0.02, 95%CI 1.16, 15.34). The MG group remained having higher VVDBPV but the magnitude of the association decreased and no statistical significance (Coef. 0.58, p 0.83, 95%CI -4.58, 5.73). Conclusions: Similar to non-transplant patients, KT recipients with pre-KT MAC had significant higher VVSBPV at the late post-KT.

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Blood Pressure Variability and Optimal Cerebral Perfusion Pressure—New Therapeutic Targets in Traumatic Brain Injury

Neurosurgery ◽

10.1093/neuros/nyz515 ◽

2019 ◽

Vol 86 (3) ◽

pp. E300-E309 ◽

Cited By ~ 2

Author(s):

Teodor Svedung Wettervik ◽

Timothy Howells ◽

Anders Lewén ◽

Per Enblad

Keyword(s):

Blood Pressure ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Cerebral Perfusion Pressure ◽

Arterial Blood Pressure ◽

Blood Pressure Variability ◽

Cerebral Perfusion ◽

Perfusion Pressure ◽

Arterial Blood ◽

Optimal Cerebral Perfusion Pressure

Abstract BACKGROUND Optimal cerebral perfusion pressure (CPPopt) is an autoregulatory-oriented target in the neurointensive care (NIC) of patients with traumatic brain injury (TBI), and deviation from CPPopt is associated with poor outcome. We recently found that blood pressure variability (BPV) is associated with deviation from CPPopt. OBJECTIVE To evaluate BPV and other variables related to deviation from CPPopt and to evaluate challenges and strategies for autoregulatory-oriented treatment in TBI. METHODS Data including arterial blood pressure and intracranial pressure (ICP) from 362 TBI patients treated at the NIC unit, Uppsala University Hospital, Sweden, between 2008 and 2016, were retrospectively analyzed day 2 to 5. RESULTS Higher BPV was a strong predictor of both CPP deviation below and above CPPopt after multiple regression analyses. There was no other explanatory variable for CPP deviation above CPPopt, whereas also higher ICP and worse autoregulation (higher pressure reactivity index) were associated with CPP deviation below CPPopt. A higher BPV was, in turn, explained by older age, lower ICP, higher mean arterial blood pressure, and higher slow arterial blood pressure amplitude (0.018-0.067 Hz). CONCLUSION BPV was strongly associated with deviation from CPPopt. High age is a risk factor for high BPV and hence CPP insults. Our treatment protocol is focused on avoiding CPP below 60 mm Hg. It is possible that a more restrictive upper level could generate more stable blood pressure and less deviation from CPPopt.

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The association of ketamine induction with blood pressure changes in paramedic rapid sequence intubation of out‐of‐hospital traumatic brain injury

Academic Emergency Medicine ◽

10.1111/acem.14256 ◽

2021 ◽

Author(s):

Pieter F. Fouche ◽

Ben Meadley ◽

Toby St Clair ◽

Alison Winnall ◽

Paul A. Jennings ◽

...

Keyword(s):

Blood Pressure ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Rapid Sequence Intubation ◽

Rapid Sequence ◽

Pressure Changes

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Reply to Comment on Tsai, Y.-C., et al. Association of Stress-Induced Hyperglycemia and Diabetic Hyperglycemia with Mortality in Patients with Traumatic Brain Injury: Analysis of a Propensity Score-Matched Population. Int. J. Environ. Res. Public Health 2020, 17, 4266

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052531 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2531

Author(s):

Yu-Chin Tsai ◽

Shao-Chun Wu ◽

Ting-Min Hsieh ◽

Hang-Tsung Liu ◽

Chun-Ying Huang ◽

...

Keyword(s):

Public Health ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Propensity Score ◽

Brain Injuries ◽

Traumatic Brain Injuries ◽

Injury Analysis

Thank you for Eduardo Mekitarian Filho’s appreciation of our work on the study of stress-induced hyperglycemia (SIH) and diabetic hyperglycemia (DH) in patients with traumatic brain injuries [...]

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