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Published on: August 24, 2011
Association Between Hyperacute Stage Blood Pressure Variability and Outcome in Patients With Spontaneous
Pil-Wook Chung1, Joon-Tae Kim2, Nerses Sanossian2
1From the Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C.); Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Neurology, University of Southern California, Los Angeles (N.S.); Comprehensive Stroke Center, Division of Emergency Medicine, and Department of Neurology (S.S.), Department of Biomathematics (J.G.), and Comprehensive Stroke Center and Department of Neurology (D.S.L., J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; School of Medicine, Stanford University, CA (S.H.); National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles (M.E.); Los Angeles Fire Department, CA (M.E.); Los Angeles County Department of Public Health, CA (F.P.); and Department of Emergency Medicine, Los Angeles EMS Agency, Orange County EMS Agency, Harbor-University of California, Los Angeles Medical Center (S.S.). chungpw@hanmail.net.
Background And Purpose:
Increased blood pressure (BP) variability, in addition to high BP, may contribute to adverse outcome in intracerebral hemorrhage. However, degree and association with outcome of BP variability (BPV) in the hyperacute period, 15 minutes to 5 hours after onset, have not been delineated.
Methods:
Among consecutive patients with intracerebral hemorrhage enrolled in the FAST-MAG trial (Field Administration of Stroke Therapy-Magnesium), BPs were recorded by paramedics in the field and during the first 24 hours of hospital course. BP was analyzed in the hyperacute period, from 0 to 4-6 hours, and in the acute period, from 0 to 24-26 hours after onset. BPV was analyzed by SD, coefficient of variation, and successive variation.
Results:
Among 386 patients with intracerebral hemorrhage, first systolic BP at median 23 minutes (interquartile range, 14-38.5) after onset was median 176 mm Hg, second systolic BP on emergency department arrival at 57 minutes (interquartile range, 45-75) after onset was 178 mm Hg, and systolic BP 24 hours after arrival was 138 mm Hg. Unfavorable outcome at 3 months (modified Rankin Scale, 3-6) occurred in 270 (69.9%). Neither mean nor maximum systolic BP was associated with outcome in multivariable analysis. However, all 3 parameters of BPV, in both the hyperacute and the acute stages, were associated with poor outcome. In the hyperacute phase, BPV was associated with poor outcome with adjusted odds ratios of 3.73 for the highest quintile of SD, 4.78 for the highest quintile of coefficient of variation, and 3.39 for the highest quintile of successive variation.
Conclusions:
BPV during the hyperacute first minutes and hours after onset in patients with intracerebral hemorrhage was independently associated with poor functional outcome. Stabilization of BPV during this vulnerable period, in the pre-hospital and early emergency department course, is a potential therapeutic target for future clinical trials.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00059332.
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