Association between Intraoperative Hypotension and Hypertension and 30-day Postoperative Mortality in Noncardiac Surgery

Abstract Background Although deviations in intraoperative blood pressure are assumed to be associated with postoperative mortality, critical blood pressure thresholds remain undefined. Therefore, the authors estimated the intraoperative thresholds of systolic blood pressure (SBP), mean blood pressure (MAP), and diastolic blood pressure (DBP) associated with increased risk-adjusted 30-day mortality. Methods This retrospective cohort study combined intraoperative blood pressure data from six Veterans Affairs medical centers with 30-day outcomes to determine the risk-adjusted associations between intraoperative blood pressure and 30-day mortality. Deviations in blood pressure were assessed using three methods: (1) population thresholds (individual patient sum of area under threshold [AUT] or area over threshold 2 SDs from the mean of the population intraoperative blood pressure values), (2). absolute thresholds, and (3) percent change from baseline blood pressure. Results Thirty-day mortality was associated with (1) population threshold: systolic AUT (odds ratio, 3.3; 95% CI, 2.2 to 4.8), mean AUT (2.8; 1.9 to 4.3), and diastolic AUT (2.4; 1.6 to 3.8). Approximate conversions of AUT into its separate components of pressure and time were SBP < 67 mmHg for more than 8.2 min, MAP < 49 mmHg for more than 3.9 min, DBP < 33 mmHg for more than 4.4 min. (2) Absolute threshold: SBP < 70 mmHg for more than or equal to 5 min (odds ratio, 2.9; 95% CI, 1.7 to 4.9), MAP < 49 mmHg for more than or equal to 5 min (2.4; 1.3 to 4.6), and DBP < 30 mmHg for more than or equal to 5 min (3.2; 1.8 to 5.5). (3) Percent change: MAP decreases to more than 50% from baseline for more than or equal to 5 min (2.7; 1.5 to 5.0). Intraoperative hypertension was not associated with 30-day mortality with any of these techniques. Conclusion Intraoperative hypotension, but not hypertension, is associated with increased 30-day operative mortality.

Download Full-text

The cumulative duration of bispectral index less than 40 concurrent with hypotension is associated with 90-day postoperative mortality: a retrospective study

10.21203/rs.3.rs-16106/v1 ◽

2020 ◽

Author(s):

Soohyuk Yoon ◽

Seokha Yoo ◽

Min Hur ◽

Sun-Kyung Park ◽

Hyung-Chul Lee ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Bispectral Index ◽

Odds Ratio ◽

Postoperative Mortality ◽

Anesthetic Depth ◽

Intraoperative Hypotension ◽

Cumulative Duration ◽

The Relationship ◽

Cumulative Time

Abstract Background The relationship between intraoperative low bispectral index (BIS) values and poor clinical outcomes has been controversial. Intraoperative hypotension is associated with postoperative complication. The purpose of this study was to investigate the influence of intraoperative low BIS values and hypotension on postoperative mortality in patients undergoing major abdominal surgery. Methods This retrospective study analyzed 1,862 cases of general anesthesia. We collected the cumulative time of BIS values below 20 and 40 as well as electroencephalographic suppression and documented the incidences in which these states were maintained for at least 5 minutes. Durations of intraoperative mean arterial pressures (MAP) less than 50 mmHg were also recorded. Multivariable logistic regression was used to evaluate the association between suspected risk factors and postoperative mortality. Results Ninety-day mortality and 180-day mortality were 1.5% and 3.2% respectively. The cumulative time in minutes for BIS values falling below 40 coupled with MAP falling below 50 mmHg was associated with 90-day mortality (odds ratio, 1.26; 95% confidence interval, 1.04-1.53; P = .019). We found no association between BIS related values and 180-day mortality. Conclusions Delicate adjustment of anesthetic depth is important to avoid excessive brain suppression and hypotension, which could be associated with postoperative mortality.

Download Full-text

Association Between Low Blood Pressure and Clinical Outcomes in Patients With Acute Ischemic Stroke

Stroke ◽

10.1161/strokeaha.119.027336 ◽

2020 ◽

Vol 51 (1) ◽

pp. 338-341

Author(s):

Merelijne A. Verschoof ◽

Adrien E. Groot ◽

Jan-Dirk Vermeij ◽

Willeke F. Westendorp ◽

Sophie A. van den Berg ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Ischemic Stroke ◽

Gastrointestinal Bleeding ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Odds Ratio ◽

Increased Risk ◽

Low Blood Pressure

Background and Purpose— Low blood pressure is uncommon in patients with acute ischemic stroke (AIS). We assessed the association between baseline low blood pressure and outcomes in patients with AIS. Methods— Post hoc analysis of the PASS (Preventive Antibiotics in Stroke Study). We compared patients with AIS and low (<10th percentile) baseline systolic blood pressure (SBP) to patients with normal SBP (≥10th percentile <185 mm Hg). The first SBP measured at the Emergency Department was used. Outcomes included in-hospital mortality, major complications <7 days of stroke onset, and functional outcome at 90 days (modified Rankin scale score). We used regression analysis to calculate (common) odds ratios and adjusted for predefined prognostic factors. Results— Two thousand one hundred twenty-four out of 2538 patients had AIS. The cutoff for low SBP was 130 mm Hg (n=212; range, 70–129 mm Hg). One thousand four hundred forty patients had a normal SBP (range, 130–184 mm Hg). Low SBP was associated with an increased risk of in-hospital mortality (8.0% versus 4.2%; adjusted odds ratio [aOR], 1.58; 95% CI, 1.13–2.21) and complications (16.0% versus 6.5%; aOR, 2.56; 95% CI, 1.60–4.10). Specifically, heart failure (2.4% versus 0.1%; aOR, 17.85; 95% CI, 3.36–94.86), gastrointestinal bleeding (1.9% versus 0.1%; aOR, 26.04; 95% CI, 2.83–239.30), and sepsis (3.3% versus 0.5%; aOR, 5.53; 95% CI, 1.84–16.67) were more common in patients with low SBP. Functional outcome at 90 days did not differ (shift towards worse outcome: adjusted common odds ratio, 1.24; 95% CI, 0.95–1.61). Conclusions— Whether it is cause or consequence, low SBP at presentation in patients with AIS was associated with an increased risk of in-hospital mortality and complications, specifically heart failure, gastrointestinal bleeding, and sepsis. Clinicians should be vigilant for potentially treatable complications. Clinical Trial Registration— URL: https://www.controlled-trials.com . Unique identifier: ISRCTN66140176.

Download Full-text

Abstract 3636: Ekg Left Ventricular Hypertrophy And Cardiovascular Events In Patients With Type 1 And Type 2 Diabetes Mellitus

Circulation ◽

10.1161/circ.116.suppl_16.ii_825-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Massimo Salvetti ◽

Maria Lorenza Muiesan ◽

Barbara Stanga ◽

Antonio Cimino ◽

Umberto Valentini ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Total Cholesterol ◽

Odds Ratio ◽

Cardiovascular Events ◽

Prognostic Significance ◽

Type 2 Dm ◽

Increased Risk

Background: A large number of studies have demonstrated that LVH detected with standard electrocardiography is an independent predictor of future cardiovascular complications in various subsets of patients. Despite the fact that ECG represents the first cardiovascular test performed in diabetics, few data are available on the prognostic significance of EKG LVH in these patients. Aim of this study was to evaluate the relationship between EKG LVH and the risk of future cardiovascular events in a wide group of patients with diabetes mellitus (DM). Methods A total of 1131 prospectively identified patients with type 1 (n=613, age 36 ± 13 years, 40 % women, BP 127 ± 16/79 ± 8 mmHg, total cholesterol 196 ± 43 mg/dl, HbA1C 7.81 ± 1.67%) and with type 2 DM (n=618, age 53 ± 11 years, 34 % women, BP 137 ± 18/82 ± 8 mmHg, total cholesterol 208 ± 41 mg/dl, HbA1C 7.97 ± 1.72%) were studied. At baseline all subjects underwent baseline clinical examination with blood pressure measurement according to current guidelines, standard laboratory examinations and a 12 leads electrocardiogram. LVH was defined as the presence of a “Sokolow-Lyon” voltage >38 mm and/or a “Cornell voltage QRS duration product” >2440 mm* msec. Treatment was not standardized. Results LVH prevalence was 8.3 % in type 2 DM and 6.4 % in type 1 DM. Patients were followed for 63 ± 27 months (range 1–126). A first non fatal cardiovascular event occurred in 62 patients. Kaplan-Meyer analysis revealed a higher risk of cardiovascular events in patients with LVH both with type 1 and type 2 DM (Log Rank Mantel Cox p<0.01). In Cox analysis, controlling for age, gender, BMI, history of cardiovascular disease, systolic blood pressure, heart rate, total plasma cholesterol, HbA1c, albuminuria and antihypertensive treatment, the presence of LVH was associated with an increased risk of cardiovascular events in all patients (odds ratio 2.96, 95% CI 1.39 to 6.32, p<0.01) and separately in DM type 1 (odds ratio 5.71, 95% CI 1.29 to 25.17, p=0.02) and in type 2 DM (odds ratio 2.92, 95% CI 1.02 to 8.35, p=0.05). Conclusions: Our data demonstrate that in patients with DM the detection of LVH by EKG is associated to an increased risk of cardiovascular events, independently of other risk factors and represent the first demonstration of the prognostic significance of EKG-LVH in patients with type 1 diabetes

Download Full-text

Patterns of Alcohol Consumption and the Metabolic Syndrome

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2007-2788 ◽

2008 ◽

Vol 93 (10) ◽

pp. 3833-3838 ◽

Cited By ~ 85

Author(s):

Amy Z. Fan ◽

Marcia Russell ◽

Timothy Naimi ◽

Yan Li ◽

Youlian Liao ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Metabolic Syndrome ◽

Alcohol Consumption ◽

Binge Drinking ◽

Odds Ratio ◽

Fasting Glucose ◽

Drinking Patterns ◽

The Metabolic Syndrome ◽

Increased Risk

Context and Objective: Protective and detrimental associations have been reported between alcohol consumption and the metabolic syndrome. This may be due to variations in drinking patterns and different alcohol effects on the metabolic syndrome components. This study is designed to examine the relationship between alcohol consumption patterns and the metabolic syndrome. Design, Setting, Participants, and Measures: The 1999–2002 National Health and Nutrition Examination Survey is a population-based survey of noninstitutionalized U.S. adults. Current drinkers aged 20–84 yr without cardiovascular disease who had complete data on the metabolic syndrome and drinking patterns were included in the analysis (n = 1529). The metabolic abnormalities comprising the metabolic syndrome included having three of the following: impaired fasting glucose/diabetes mellitus, high triglycerides, abdominal obesity, high blood pressure, and low high-density-lipoprotein cholesterol. Measures of alcohol consumption included usual quantity consumed, drinking frequency, and frequency of binge drinking. Results: In multinomial logistic regression models controlling for demographics, family history of cardiovascular disease and diabetes, and lifestyle factors, increased risk of the metabolic syndrome was associated with daily consumption that exceeded U.S. dietary guideline recommendations (more than one drink per drinking day for women and more than two drinks per drinking day for men (odds ratio 1.60, 95% confidence interval 1.22–2.11) and binge drinking once per week or more [odds ratio (95% confidence interval) 1.51 (1.01–2.29]. By individual metabolic abnormality, drinking in excess of the dietary guidelines was associated with an increased risk of impaired fasting glucose/diabetes mellitus, hypertriglyceridemia, abdominal obesity, and high blood pressure. Conclusion: Public health messages should emphasize the potential cardiometabolic risk associated with drinking in excess of national guidelines and binge drinking.

Download Full-text

Analysis of intraoperative modifiable factors to prevent acute kidney injury after elective noncardiac surgery: intraoperative hypotension and crystalloid administration related to acute kidney injury

JA Clinical Reports ◽

10.1186/s40981-021-00429-9 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yasuma Kobayashi ◽

Kazue Yamaoka

Keyword(s):

Blood Pressure ◽

Acute Kidney Injury ◽

Kidney Injury ◽

Noncardiac Surgery ◽

Intraoperative Hypotension ◽

Increased Risk ◽

Modifiable Factors ◽

Blood Pressure Range ◽

Crystalloid Administration ◽

Administration Protocol

Abstract Background The optimal intraoperative blood pressure range and crystalloid administration protocol for the prevention of acute kidney injury (AKI) after elective noncardiac surgery remain unknown. Methods This single-center retrospective cohort study included 6296 patients aged ≥ 50 years who had undergone elective noncardiac surgery under general anesthesia. We evaluated the relationship between duration of intraoperative hypotension and AKI. To assess whether the effects of crystalloid administration differed according to baseline estimated glomerular filtration rate (eGFR), we examined the interaction between intraoperative crystalloid administration and eGFR. We calculated univariable and multivariable adjusted odds ratios (ORs) and their 95% confidence intervals (95% CIs) for the prevalence of AKI. Results AKI occurred in 431 (6.8%) patients and was associated with intraoperative hypotension. Effects of intraoperative crystalloid administration differed significantly according to baseline eGFR. Increased risk of AKI was noted in patients with eGFR ≤45 ml min−1 1.73m−2 who were managed with restrictive or liberal crystalloid administration [OR 4.79 (95% CI 3.10 to 7.32) and 6.43 (95% CI 2.23 to 16.03), respectively] as opposed to those with eGFR >45 ml min−1 1.73m−2 who were managed with moderately restrictive crystalloid administration. Conclusions Our findings suggest that anesthesiologists should avoid intraoperative hypotension as well as either restrictive or liberal (as opposed to moderately restrictive) crystalloid administration in patients with decreased eGFR. Intraoperative blood pressure and crystalloid administration protocol are major modifiable factors that must be optimized to prevent postoperative AKI.

Download Full-text

Blood Pressure Trajectory Groups and Outcome After Endovascular Thrombectomy: A Multicenter Study

Stroke ◽

10.1161/strokeaha.121.034408 ◽

2021 ◽

Author(s):

Nils H. Petersen ◽

Sreeja Kodali ◽

Can Meng ◽

Fangyong Li ◽

Cindy Khanh Nguyen ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Odds Ratio ◽

Functional Outcomes ◽

Adjusted Odds Ratio ◽

Hemorrhagic Transformation ◽

Endovascular Thrombectomy ◽

Increased Risk ◽

Symptomatic Intracranial Hemorrhage ◽

Trajectory Group

Background and Purpose: Elevated blood pressure after endovascular thrombectomy (EVT) has been associated with an increased risk of hemorrhagic transformation and poor functional outcomes. However, the optimal hemodynamic management after EVT remains unknown, and the blood pressure course in the acute phase of ischemic stroke has not been well characterized. This study aimed to identify patient subgroups with distinct blood pressure trajectories after EVT and study their association with radiographic and functional outcomes. Methods: This multicenter retrospective cohort study included consecutive patients with anterior circulation large-vessel occlusion ischemic stroke who underwent EVT. Repeated time-stamped blood pressure data were recorded for the first 72 hours after thrombectomy. Latent variable mixture modeling was used to separate subjects into five groups with distinct postprocedural systolic blood pressure (SBP) trajectories. The primary outcome was functional status, measured on the modified Rankin Scale 90 days after stroke. Secondary outcomes included hemorrhagic transformation, symptomatic intracranial hemorrhage, and death. Results: Two thousand two hundred sixty-eight patients (mean age [±SD] 69±15, mean National Institutes of Health Stroke Scale 15±7) were included in the analysis. Five distinct SBP trajectories were observed: low (18%), moderate (37%), moderate-to-high (20%), high-to-moderate (18%), and high (6%). SBP trajectory group was independently associated with functional outcome at 90 days ( P <0.0001) after adjusting for potential confounders. Patients with high and high-to-moderate SBP trajectories had significantly greater odds of an unfavorable outcome (adjusted odds ratio, 3.5 [95% CI, 1.8–6.7], P =0.0003 and adjusted odds ratio, 2.2 [95% CI, 1.5–3.2], P <0.0001, respectively). Subjects in the high-to-moderate group had an increased risk of symptomatic intracranial hemorrhage (adjusted odds ratio, 1.82 [95% CI, 1–3.2]; P =0.04). No significant association was found between trajectory group and hemorrhagic transformation. Conclusions: Patients with acute ischemic stroke demonstrate distinct SBP trajectories during the first 72 hours after EVT that have differing associations with functional outcome. These findings may help identify potential candidates for future blood pressure modulation trials.

Download Full-text

Defining an Intraoperative Hypotension Threshold in Association with De Novo Renal Replacement Therapy after Cardiac Surgery

Anesthesiology ◽

10.1097/aln.0000000000003254 ◽

2020 ◽

Vol 132 (6) ◽

pp. 1447-1457 ◽

Cited By ~ 1

Author(s):

Janet M. C. Ngu ◽

Habib Jabagi ◽

Amy M. Chung ◽

Munir Boodhwani ◽

Marc Ruel ◽

...

Keyword(s):

Cardiac Surgery ◽

Risk Factor ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

De Novo ◽

Intraoperative Hypotension ◽

Increased Risk ◽

The Impact

Abstract Background Acute kidney injury (AKI) is a frequent and deadly complication after cardiac surgery. In the absence of effective therapies, a focus on risk factor identification and modification has been the mainstay of management. The authors sought to determine the impact of intraoperative hypotension on de novo postoperative renal replacement therapy in patients undergoing cardiac surgery, hypothesizing that prolonged periods of hypotension during and after cardiopulmonary bypass (CPB) were associated with an increased risk of renal replacement therapy. Methods Included in this single-center retrospective cohort study were adult patients who underwent cardiac surgery requiring CPB between November 2009 and April 2015. Excluded were patients who were dialysis dependent, underwent thoracic aorta or off-pump procedures, or died before receiving renal replacement therapy. Degrees of hypotension were defined by mean arterial pressure (MAP) as less than 55, 55 to 64, and 65 to 74 mmHg before, during, and after CPB. The primary outcome was de novo renal replacement therapy. Results Of 6,523 patient records, 336 (5.2%) required new postoperative renal replacement therapy. Each 10-min epoch of MAP less than 55 mmHg post-CPB was associated with an adjusted odds ratio of 1.13 (95% CI, 1.05 to 1.23; P = 0.002), and each 10-min epoch of MAP between 55 and 64 mmHg post-CPB was associated with an adjusted odds ratio of 1.12 (95% CI, 1.06 to 1.18; P = 0.0001) for renal replacement therapy. The authors did not observe an association between hypotension before and during CPB with renal replacement therapy. Conclusions MAP less than 65 mmHg for 10 min or more post-CPB is associated with an increased risk of de novo postoperative renal replacement therapy. The association between intraoperative hypotension and AKI was weaker in comparison to factors such as renal insufficiency, heart failure, obesity, anemia, complex or emergent surgery, and new-onset postoperative atrial fibrillation. Nonetheless, post-CPB hypotension is a potentially easier modifiable risk factor that warrants further investigation. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Download Full-text

Intraoperative Care Transitions Are Not Associated with Postoperative Adverse Outcomes

Anesthesiology ◽

10.1097/aln.0000000000001246 ◽

2016 ◽

Vol 125 (4) ◽

pp. 690-699 ◽

Cited By ~ 13

Author(s):

Maxim A. Terekhov ◽

Jesse M. Ehrenfeld ◽

Richard P. Dutton ◽

Oscar D. Guillamondegui ◽

Barbara J. Martin ◽

...

Keyword(s):

Odds Ratio ◽

Care Transitions ◽

Postoperative Mortality ◽

Adverse Outcomes ◽

Anesthesia Care ◽

Composite Outcome ◽

Improvement Program ◽

Increased Risk ◽

Duration Of Surgery ◽

The Relationship

Abstract Background Whether anesthesia care transitions and provision of short breaks affect patient outcomes remains unclear. Methods The authors determined the number of anesthesia handovers and breaks during each case for adults admitted between 2005 and 2014, along with age, sex, race, American Society of Anesthesiologists physical status, start time and duration of surgery, and diagnosis and procedure codes. The authors defined a collapsed composite of in-hospital mortality and major morbidities based on primary and secondary diagnoses. The relationship between the total number of anesthesia handovers during a case and the collapsed composite outcome was assessed with a multivariable logistic regression. The relationship between the total number of anesthesia handovers during a case and the components of the composite outcome was assessed using multivariate generalized estimating equation methods. Additionally, the authors analyzed major complications and/or death within 30 days of surgery based on the American College of Surgeons National Surgical Quality Improvement Program–defined events. Results A total of 140,754 anesthetics were identified for the primary analysis. The number of anesthesia handovers was not found to be associated (P = 0.19) with increased odds of postoperative mortality and serious complications, as measured by the collapsed composite, with odds ratio for a one unit increase in handovers of 0.957; 95% CI, 0.895 to 1.022, when controlled for potential confounding variables. A total of 8,404 anesthetics were identified for the NSQIP analysis (collapsed composite odds ratio, 0.868; 95% CI, 0.718 to 1.049 for handovers). Conclusions In the analysis of intraoperative handovers, anesthesia care transitions were not associated with an increased risk of postoperative adverse outcomes.

Download Full-text

Determinants of Intracranial Hemorrhage Incidence in Patients on Oral Anticoagulation Followed at the Lahey Clinic.

Blood ◽

10.1182/blood.v116.21.1101.1101 ◽

2010 ◽

Vol 116 (21) ◽

pp. 1101-1101

Author(s):

Simon Mantha ◽

Ann M Pianka ◽

Nicholas P Tsapatsaris

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Blood Pressure ◽

Intracranial Hemorrhage ◽

Oral Anticoagulation ◽

Odds Ratio ◽

Univariate Analysis ◽

Mean Blood Pressure ◽

Increased Risk ◽

Blood Pressures

Abstract Abstract 1101 Background: oral anticoagulation with warfarin is used to treat venous and arterial thromboembolic disease. Its administration is associated with a risk of intracranial hemorrhage (ICH), a devastating complication which usually results in death or severe disability. The international normalized ratio (INR) is one of the factors which can help determine the risk of ICH in a given individual (Singer DE et al, Circ Cardiovasc Qual Outcomes 2009). Materials and methods: using the DoseResponse® patient database at our institution, we carried out a retrospective nested matched case-control study to identify patient characteristics associated with the occurrence of ICH. The database was queried for the years 2007 to 2009. Each case was matched by month to 4 control patients having a routine INR determination for the monitoring of chronic anticoagulation. The following characteristics were captured: INR, age, sex, systolic and diastolic blood pressure, hemoglobin, creatinine, history of pertinent medical conditions (hypertension, diabetes, heart failure, gastrointestinal bleeding, ischemic stroke, active cancer, substance abuse, cirrhosis), indication for anticoagulation (non-valvular atrial fibrillation, valvular atrial fibrillation, venous thromboembolism or other) and intake of antiplatelet agent. Blood pressure for cases was obtained from a medical encounter occurring before the bleeding event. The relationship between those risk factors and the odds ratio of ICH was determined with conditional logistic regression, using the SAS® 9.2 software platform. The initial approach consisted of stepwise regression with forward selection and backward elimination. Results: 31 cases of ICH were retrieved; they were matched to 124 controls. In the univariate analysis, the two groups differed significantly only in terms of their hemoglobin: 12.8 versus 13.5 g/dL for cases and controls, respectively (p=0.048). As for the INR, the mean value was 3.0 for cases vs 2.5 for controls. The distribution of this parameter was normal albeit more markedly skewed to the right for cases, with 3 values of 5.0 or more, compared to only one instance of this for controls. Most cases of ICH occurred in the setting of a therapeutic INR. The odds ratio (OR) of ICH (using the interval 2.01 to 2.50 as the reference) started increasing above an INR of 3.50, reaching its highest level in individuals with an INR value greater than 4.50 (OR=5.78, 95% CI=1.10-30.48). Mean blood pressures were similar between the two groups: 92 vs 89 mmHg for cases vs controls, respectively (p=0.252). The variables retained in the final regression model on the basis of statistical significance and clinical pertinence are shown in the table. The OR of ICH was 1.50 for increments of 1.0 in INR value (p=0.021), while it was 1.56 for increments of 10 mmHg in mean blood pressure (p=0.032). The presence of cancer, anemia and heart failure appeared to contribute to the risk of an event but the associations for those factors were not statistically significant. Conclusion: the INR is an important predictor for the incidence of ICH, but a supratherapeutic measurement is found only in a minority of cases; the risk of an event increases markedly with an INR above 3.5. Mean blood pressure is another important determinant of the risk of ICH in individuals on chronic warfarin therapy. Previous studies have shown that a diagnosis of hypertension is associated with an increased risk of ICH in the anticoagulated patient population (Berwaerts J et al, QJM 2000; Atrial Fibrillation Investigators, Arch Intern Med 1994; Singer DE et al, Ann Intern Med 2009), but to the knowledge of this author there has been no report describing the variation in this risk over the spectrum of mean blood pressures. This lends support to the generally accepted practice of aggressively treating arterial hypertension in patients on chronic oral anticoagulation. Multivariable Analysis Disclosures: No relevant conflicts of interest to declare.

Download Full-text

BMI increase through puberty and adolescence is associated with risk of adult stroke

Neurology ◽

10.1212/wnl.0000000000004158 ◽

2017 ◽

Vol 89 (4) ◽

pp. 363-369 ◽

Cited By ~ 20

Author(s):

Claes Ohlsson ◽

Maria Bygdell ◽

Arvid Sondén ◽

Christina Jern ◽

Annika Rosengren ◽

...

Keyword(s):

Blood Pressure ◽

Body Mass Index ◽

Ischemic Stroke ◽

Odds Ratio ◽

Population Based ◽

High Quality ◽

Population Based Study ◽

Childhood Body Mass Index ◽

Increased Risk ◽

High Bmi

Objective:To evaluate the contribution of prepubertal childhood body mass index (BMI) and BMI change through puberty and adolescence, 2 distinct developmental BMI parameters, for risk of adult stroke in men.Methods:In this population-based study in Gothenburg, Sweden, men born in 1945–1961 with information on both childhood BMI at age 8 and BMI change through puberty and adolescence (BMI at age 20–BMI at age 8) were followed until December 2013 (n = 37,669). Information on stroke events was retrieved from high-quality national registers (918 first stroke events, 672 ischemic stroke events [IS], 207 intracerebral hemorrhage events [ICH]).Results:BMI increase through puberty and adolescence (hazard ratio [HR] 1.21 per SD increase; 95% confidence interval [CI] 1.14–1.28), but not childhood BMI, was independently associated with risk of adult stroke. Subanalyses revealed that BMI increase through puberty and adolescence was associated with both IS (HR per SD increase 1.19; 95% CI 1.11–1.28) and ICH (HR per SD increase 1.29; 95% CI 1.15–1.46). High BMI increase during puberty was strongly associated with increased risk of adult hypertension (odds ratio per SD increase 1.35; 95% CI 1.32–1.39).Conclusions:BMI increase through puberty and adolescence is associated with risk of adult IS and ICH in men. We propose that greater BMI increases during puberty contribute to increased risk of adult stroke at least partly via increased blood pressure.

Download Full-text