Abstract W P328: Elevated Systolic Blood Pressure on Arrival is Not Associated with Higher Early Mortality in Intracerebral Hemorrhage Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Kara A Sands ◽  
Karen C Albright ◽  
Kimberly Kicielinski ◽  
Harn Shiue ◽  
April Sisson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Systolic Blood Pressure ◽  
Clinical Investigation ◽  
Early Mortality ◽  
Stroke Severity ◽  
Significant Independent Predictor ◽  
Elevated Systolic Blood Pressure ◽  
Ich Score

Background and Purpose: The role of blood pressure control in the initial management of patients with intracerebral hemorrhage (ICH) is an active area of clinical investigation. Although ICH score is a validated predictor of in-hospital mortality in patients with ICH, it is not known whether elevated systolic blood pressure (SBP) on arrival is predictive of early mortality. We hypothesized that elevated SBP on arrival would be associated with in-hospital mortality in primary ICH patients. Methods: We retrospectively analyzed consecutive spontaneous ICH patients at our institution from 2008-2013. Patients were excluded if they were under the care of a palliative physician. We examined demographics, vascular risk factors, stroke severity (NIHSS), ICH score, and laboratory values. Results: A total of 361 spontaneous ICH patients (median age 63, 43% black, 42% female) met inclusion criteria. Over half of ICH patients were transferred into our facility (54%). Sixty-four percent of patients arrived with SBP >160. The association of SBP on arrival and in-hospital mortality is depicted in Figure 1. Conclusions: After adjusting for ICH score, SBP was not a significant independent predictor of death during the hospitalization. This finding suggests that clinical trials of blood pressure management of patients with ICH should stratify patients according to ICH score.

Abstract 1122‐000166: Stroke Severity Factors in patients with Acute Ischemic Stroke and Heart Failure Stratifying by Age

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Camron K Edrissi ◽  
Carolyn Sanders ◽  
Chase Rathfoot ◽  
Krista Knisely ◽  
Thomas Nathaniel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ischemic Stroke ◽  
Systolic Blood Pressure ◽  
Acute Ischemic Stroke ◽  
Heart Valve ◽  
Prosthetic Heart Valve ◽  
Stroke Severity ◽  
Factors Associated ◽  
Elevated Systolic Blood Pressure

Introduction : The goal of this study is to investigate the clinical risk factors associated with acute ischemic stroke (AIS) severity in heart failure (HF) patients above and below 70 years old using the National Institutes of Health Stroke Scale (NIHSS) as a measure for stroke severity. Methods : This study uses retrospective analysis of AIS patients who were previously diagnosed with HF. Data was collected from a regional stroke center from January 2010 to June 2016. Multivariate logistic regression identified the factors associated with stroke severity, with a NIHSS score <7 indicating low severity and a score ≥7 indicating high severity. These results were stratified by patient ages of < and ≥70 years old. Results : A total of 590 patients presented with AIS and a previous diagnosis of HF. The AIS‐HF population contained 223 patients that were <70 years old and 367 that were ≥70 years old. In the AIS‐HF population, patients who were ≥70 years old who presented with coronary artery stenosis (CAS) (OR = 8.592, 95% CI, 2.123‐34.772, P <0.003), prosthetic heart valve (OR = 22.028, 95% CI, 1.454‐333.746, P <0.026), elevated systolic blood pressure (OR = 1.014, 95% CI, 1.002‐1.026, P < 0.024), and tissue plasminogen activator (tPA) administration (OR = 4.002, 95% CI, 1.912‐8.377, P < 0.001) were associated with a higher NIHSS. Alternatively, those that presented with gender differences (OR = 0.466, 95% CI, 0.235‐0.925, P < 0.029), family history of stroke (OR = 0.084, 95% CI, 0.010‐0.726, P < 0.024), obesity (OR = 0.493, 95% CI, 0.261‐0.930, P < 0.029), smoking (OR = 0.253, 95% CI, 0.063‐1.022, P < 0.054), serum creatinine (OR = 0.629, 95% CI, 0.399‐0.992, P < 0.046), INR level (OR = 0.457, 95% CI, 0.191‐1.094, P < 0.079) were associated with a lower NIHSS. Conclusions : The data revealed a variety of components that may affect Stroke Severity in AIS patients with HF. The associated factors exhibited significant differences between distinct age groups. AIS‐HF patients ≥70 years old who presented with CAS, prosthetic heart valve, elevated systolic blood pressure, and received tPA administration were associated with higher stroke severity (≥7 NIHSS) compared to <70 years old group. Identifying more concrete clinical and demographic associations may aid in the identification and evidence‐based management of patients who suffer from AIS.

scholarly journals Tubular Deficiency of Heterogeneous Nuclear Ribonucleoprotein F Elevates Systolic Blood Pressure and Induces Glycosuria in Mice

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Chao-Sheng Lo ◽  
Kana N. Miyata ◽  
Shuiling Zhao ◽  
Anindya Ghosh ◽  
Shiao-Ying Chang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Interstitial Fibrosis ◽  
Sglt2 Inhibitor ◽  
Systemic Hypertension ◽  
Male And Female ◽  
Heterogeneous Nuclear Ribonucleoprotein ◽  
Elevated Systolic Blood Pressure ◽  
Nuclear Ribonucleoprotein ◽  
Heterogeneous Nuclear Ribonucleoprotein F

Abstract We reported previously that overexpression of heterogeneous nuclear ribonucleoprotein F (Hnrnpf) in renal proximal tubular cells (RPTCs) suppresses angiotensinogen (Agt) expression, and attenuates systemic hypertension and renal injury in diabetic Hnrnpf-transgenic (Tg) mice. We thus hypothesized that deletion of Hnrnpf in the renal proximal tubules (RPT) of mice would worsen systemic hypertension and kidney injury, perhaps revealing novel mechanism(s). Tubule-specific Hnrnpf knockout (KO) mice were generated by crossbreeding Pax8-Cre mice with floxed Hnrnpf mice on a C57BL/6 background. Both male and female KO mice exhibited elevated systolic blood pressure, increased urinary albumin/creatinine ratio, tubulo-interstitial fibrosis and glycosuria without changes in blood glucose or glomerular filtration rate compared with control littermates. However, glycosuria disappeared in male KO mice at the age of 12 weeks, while female KO mice had persistent glycosuria. Agt expression was elevated, whereas sodium-glucose co-transporter 2 (Sglt2) expression was down-regulated in RPTs of both male and female KO mice as compared to control littermates. In vitro, KO of HNRNPF in human RPTCs (HK-2) by CRISPR gRNA up-regulated AGT and down-regulated SGLT2 expression. The Sglt2 inhibitor canagliflozin treatment had no effect on Agt and Sglt2 expression in HK-2 and in RPTCs of wild-type mice but induced glycosuria. Our results demonstrate that Hnrnpf plays a role in the development of hypertension and glycosuria through modulation of renal Agt and Sglt2 expression in mice, respectively.

Abstract 026: High In-Hospital Systolic Blood Pressure Variability and Poor Functional Outcomes in Primary Intracerebral Hemorrhage Patients

Hypertension ◽  
2018 ◽  
Vol 72 (Suppl_1) ◽  
Author(s):  
Jennifer R Meeks ◽  
Arvind B Bambhroliya ◽  
Ellie G Meyer ◽  
Kristen B Slaughter ◽  
Christopher J Fraher ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Systolic Blood Pressure ◽  
Functional Outcomes ◽  
Blood Pressure Variability ◽  
Systolic Blood Pressure Variability

Abstract WP334: In-hospital Systolic Blood Pressure Variability in Elderly Patients With Primary Intracerebral Hemorrhage

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Jennifer R Meeks ◽  
Arvind B Bambhroliya ◽  
Ellie G Meyer ◽  
Kristen B Slaughter ◽  
Christopher J Fraher ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Elderly Patients ◽  
Intracerebral Hemorrhage ◽  
Systolic Blood Pressure ◽  
Blood Pressure Variability ◽  
Systolic Blood Pressure Variability

Statistical analysis plan for pooled individual patient data from two landmark randomized trials (INTERACT2 and ATACH-II) of intensive blood pressure lowering treatment in acute intracerebral hemorrhage

2018 ◽  
Vol 14 (3) ◽  
pp. 321-328 ◽  
Author(s):  
Tom J Moullaali ◽  
Xia Wang ◽  
Renee' H Martin ◽  
Virginia B Shipes ◽  
Adnan I Qureshi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Systolic Blood Pressure ◽  
Functional Recovery ◽  
Modified Rankin Scale ◽  
Blood Pressure Lowering ◽  
Safety Outcomes ◽  
Pressure Lowering ◽  
Acute Intracerebral Hemorrhage ◽  
Intensive Blood Pressure

Background There is persistent uncertainty over the benefits of early intensive systolic blood pressure lowering in acute intracerebral hemorrhage. In particular, over the timing, target, and intensity of systolic blood pressure control for optimum balance of potential benefits (i.e. functional recovery) and risks (e.g. cerebral ischemia). Aims To determine associations of early systolic blood pressure lowering parameters and outcomes in patients with a hypertensive response in acute intracerebral hemorrhage. Secondary aims are to identify the modifying effects of patient characteristics and an optimal systolic blood pressure lowering profile. Methods Individual participant data pooled analyses of two large, multicenter, randomized controlled trials specifically undertaken to assess the effects of early intensive systolic blood pressure reduction on clinical outcomes in acute intracerebral hemorrhage: the Intensive Blood Pressure in Acute Intracerebral Hemorrhage Trial (INTERACT2) and the Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH-II) trial. Combined data will include baseline characteristics; systolic blood pressure in the first 24 h; process of care measures; and key efficacy and safety outcomes. Outcomes The primary outcome is functional recovery, defined by an ordinal distribution of scores on the modified Rankin scale at 90 days post-randomization. Secondary outcomes include various standard binary cut-points for disability-free survival on the modified Rankin scale, and health-related quality of life at 90 days. Safety outcomes include symptomatic hypotension requiring corrective therapy and early neurologic deterioration within 24 h, and deaths, any serious adverse event, and cardiac and renal serious adverse events, within 90 days. Discussion A pre-determined protocol was developed to facilitate successful collaboration and reduce analysis bias arising from prior knowledge of the findings. Clinical trial registration URL: http://www.clinicaltrials.gov . Unique identifiers for INTERACT2 (NCT00716079) and ATACH-II (NCT01176565).

scholarly journals Outcome of Primary Intracerebral Hemorrhage: A Study in Tertiary Care Center

2020 ◽  
Vol 2 (2) ◽  
pp. 35-40
Author(s):  
Jagat Narayan Rajbanshi ◽  
Pankaj Raj Nepal
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Systolic Blood Pressure ◽  
Care Center ◽  
Tertiary Care ◽  
Brain Parenchyma ◽  
Chronic Hypertension ◽  
Midline Shift ◽  
Male Predominance ◽  
The Mean

 Background: Intracerebral hemorrhage (ICH) is an irreversible phenomenon inside the brain parenchyma resulting in mild to severe neurological deficit. Based on etiology it is broadly divided into primary and secondary. Primary ICH is usually due to the rupture of Charcot-Bouchard aneurysm and chronic hypertension. Charcot – Bouchard aneurysms are supposed to get formed due to lipohyalinosis. With the aim to evaluate the outcome of primary ICH admitted to our institute this study is performed. Materials and methods: This is a prospective analytical study, where all the consecutive patients of the primary ICH were collected. Quantitative variables like age, the volume of hematoma, midline shift, GCS, and systolic blood pressure (SBP) were presented as mean and standard deviation (S.D). Whereas, qualitative variables like gender, site, and side of hematoma, type of treatment, best motor response were presented in frequency and percentage. The outcome of the patient was measured using the Glasgow outcome scale (GOS) and the association between qualitative/quantitative variables and GOS was done using the chi-square test or Fischer exact test whenever applicable in SPSS20. Results: There were a total of 31 patients with a mean age of 59.81(S. D 15.8) year and male predominance (74%). The mean volume of hematoma was 40 ml. Similarly, midline shift ranged from zero to 14 mm. The majority of primary ICH were located in basal ganglia (35%) and on the right side (52%). The mean GCS at presentation was 12.1 (S.D 2.166). Mean Systolic blood pressure was 163.77 mmHg (S.D 34.6 mmHg) with maximum SBP up to 240mmHg. There was a 14% mortality in this study group with favorable outcome (GOS 4 and 5) in 82%. GOS was significantly associated with the volume of hematoma and midline shift. Conclusion: The outcome of primary ICH is strongly associated with the volume of hematoma and midline shift. They were generally associated with hypertension with a mean systolic blood pressure of >160 mm Hg.

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