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Published on: September 22, 2012
Increased Blood Pressure Variability Contributes to Worse Outcome After Intracerebral Hemorrhage
Adam de Havenon1, Jennifer J Majersik1, Gregory Stoddard2
1From the Department of Neurology (A.d.H., J.J.M., K.-H.W.).
Insights
Increased systolic blood pressure variability (BPV) is linked to poorer neurological outcomes after intracerebral hemorrhage. This study found elevated BPV, not mean blood pressure, correlated with worse long-term results in the ATACH-2 trial.
Area of Science:
- Neurology
- Cardiovascular Research
- Clinical Trials
Background:
- Elevated systolic blood pressure variability (BPV) is linked to adverse outcomes in acute ischemic stroke.
- Potential negative impact of BPV on outcomes after intracerebral hemorrhage (ICH) is less understood.
Purpose of the Study:
- To investigate the detrimental effect of increased systolic BPV in patients following acute intracerebral hemorrhage.
- Secondary analysis of the ATACH-2 (Antihypertensive Treatment of Acute Cerebral Hemorrhage II) trial data.
Main Methods:
- Analysis of systolic blood pressure (SBP) mean and variability during acute (2-24h) and subacute (days 2, 3, 7) periods post-randomization.
- Utilized 5 statistical measures to assess SBP variability.
- Primary outcome: modified Rankin Scale (mRS) 3-6 at 3 months; Secondary outcome: utility-weighted mRS.
Main Results:
- Consistent association found between higher systolic BPV and worse neurological outcomes across both acute and subacute periods.
- No significant association was observed between mean systolic blood pressure and neurological outcome.
- Analysis included 913 patients in the acute period and 877 in the subacute period.
Conclusions:
- Increased systolic blood pressure variability is associated with worse long-term neurological outcomes in patients with ICH.
- Further research is required to identify patients at risk for elevated BPV and develop strategies to minimize it.
Abstract:
Background and Purpose- Increased systolic blood pressure variability (BPV) is associated with worse outcome after acute ischemic stroke and may also have a negative impact after intracerebral hemorrhage. We sought to determine whether increased BPV was detrimental in the ATACH-2 (Antihypertensive Treatment of Acute Cerebral Hemorrhage II) trial. Methods- The primary outcome of our study was a 3-month follow-up modified Rankin Scale of 3 to 6, and the secondary outcome was a utility-weighted modified Rankin Scale. We calculated blood pressure mean and variability using systolic blood pressure from the acute period (2-24 hours postrandomization) and subacute period (days 2, 3, and 7). Results- The acute period included 913 patients and the subacute included 877. For 5 different statistical measures of systolic BPV, there was a consistent association between increased BPV and worse neurological outcome in both the acute and subacute periods. This association was not found for systolic blood pressure mean. Conclusions- In this secondary analysis of ATACH-2, we show that increased systolic BPV is associated with worse long-term neurological outcome. Additional research is needed to find techniques that allow early identification of patients with an expected elevation of BPV and to study pharmacological or protocol-based approaches to minimize BPV.
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