Predicting Blood Pressure and Blood Pressure Variability in Spontaneous Intracerebral Hemorrhage in the Emergency...

Area of Science:

• Neurology
• Emergency Medicine
• Cardiology

Background:

• Spontaneous intracerebral hemorrhage (sICH) is a severe stroke type requiring critical blood pressure management.
• Current guidelines emphasize blood pressure reduction, but the impact of blood pressure variability (BPV) in the emergency department (ED) remains understudied.

Purpose of the Study:

• To identify predictors of achieving a target systolic blood pressure (SBP) ≤160 mmHg at ED discharge.
• To identify predictors of blood pressure variability (BPV) during the ED course for patients with sICH.

Main Methods:

• Retrospective analysis of prospectively collected data from 142 adult patients with sICH treated between 2017 and 2020.
• Machine learning algorithms were employed to determine predictors for SBP at ED discharge and BPV measures (successive variation and standard deviation).

Main Results:

• 60% of patients achieved an SBP ≤160 mmHg at ED discharge (mean 133 mmHg vs. 184 mmHg).
• Top predictors for achieving target SBP included initial ED SBP, serum sodium, clevidipine, glucose, and creatinine.
• Mechanical ventilation, serum glucose, and initial ED SBP were predictors of increased BPV.

Conclusions:

• Initial SBP in the ED is the primary predictor for achieving target SBP at discharge in sICH patients.
• Factors such as mechanical ventilation, elevated serum glucose, and high initial SBP are associated with increased BPV.
• These findings suggest clinicians should consider these predictors in managing sICH patients in the ED.