SAN DIEGO – Patients with greater variability in systolic blood pressure in the first day or week after an acute intracerebral hemorrhage were more likely to die within 90 days or have a major disability, a secondary analysis of data on 2,839 patients found.
The study compared patient outcomes with data from 5 blood pressure measurements taken within 24 hours of an acute intracerebral hemorrhage and 12 measurements taken in days 2-7 after the hemorrhage. The investigators described blood pressure variability as a standard deviation of systolic pressure, divided into quintiles.
Dr. Lisa Manning
They found a significant linear association between systolic pressure variability and death or major disability at 90 days that was independent of mean systolic blood pressure. The risk for death or disability was 41% higher in patients in the highest quintile of systolic variability within 24 hours of an acute intracerebral hemorrhage, compared with patients in the lowest quintile. The risk was 57% higher in the highest quintile of systolic variability in days 2-7 after the hemorrhage, compared with the lowest quintile, Dr. Lisa Manning reported at the International Stroke Conference.
The greatest predictors of death or major disability were maximum systolic blood pressure in the first 24 hours after a hemorrhage and standard deviation in systolic pressure in days 2-7, said Dr. Manning of the University of Leicester (England).
Similar significant associations were seen for the secondary outcome, which was an ordinal shift in modified Rankin Scale scores at 90 days. The likelihood of this shift was 43% higher in patients in the highest quintile of systolic variability in the first day after a hemorrhage and 46% higher in patients in the highest quintile of variability in days 2-7, compared with the lowest-quartile patients, she said at the meeting, sponsored by the American Heart Association.
The results were published online in Lancet Neurology (2014 Feb. 13 [doi:10.1016/S1474-4422(14)70018-3]).
Data for the analysis came from the INTERACT2 trial (The Second Intensive Blood Pressure in Acute Haemorrhage trial). The prospective, international multicenter study randomized patients with spontaneous intracerebral hemorrhage and high systolic blood pressure to early intensive lowering of blood pressure (within 1 hour of randomization) or to conventional treatment as recommended in guidelines. Results showed no significant reduction in the risk of death or disability with early intensive treatment (N. Engl. J. Med. 2013;368:2355-65).
For the current analysis, investigators studied data on 2,645 patients with blood pressure measurement in the first day after a hemorrhage (93% of the INTERACT2 cohort) and 2,347 patients with measurements in days 2-7 (83% of the total cohort).
The findings present several clinical implications, Dr. Manning suggested. Consistent, sustained efforts to control blood pressure in the first few days after an acute intracerebral hemorrhage may benefit patients, and clinicians may want to adjust the frequency and intensity of blood pressure monitoring to ensure that systolic blood pressure consistently falls and stabilizes throughout hospitalization in these patients.
The increased risk for death or disability with greater systolic variability was seen after investigators adjusted for the effects of other factors such as age, sex, the randomized treatment group, geographical region, hematoma volume at baseline, and high scores on the National Institutes of Health Stroke Scale.
The study was funded by the National Health and Medical Research Council of Australia. Two of Dr. Manning’s associates in the study reported financial associations with Osaka Pharmaceuticals, Novartis, Omron Healthcare, Pfizer, Takeda, A&D Pharma, and/or Servier.
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