Continuous Blood Pressure Indices During the First 72 Hours and Functional Outcome in Patients with Spontaneous Intracerebral Hemorrhage

Annerose Mengel; Vasileios Siokas; Rebecca Buesink; Sara Roesch; Kornelia Laichinger; Redina Ferizi; Efthimios Dardiotis; Jennifer Sartor-Pfeiffer; Constanze Single; Till-Karsten Hauser; Markus Krumbholz; Ulf Ziemann; Katharina Feil

doi:10.1007/s12028-024-02146-4

Continuous Blood Pressure Indices During the First 72 Hours and Functional Outcome in Patients with Spontaneous Intracerebral Hemorrhage

Neurocrit Care. 2024 Oct 25. doi: 10.1007/s12028-024-02146-4. Online ahead of print.

Authors

Annerose Mengel^{1

2}, Vasileios Siokas^{3

4

5}, Rebecca Buesink³, Sara Roesch³, Kornelia Laichinger^{3

4}, Redina Ferizi³, Efthimios Dardiotis⁵, Jennifer Sartor-Pfeiffer^{3

4}, Constanze Single^{3

4}, Till-Karsten Hauser⁶, Markus Krumbholz⁷, Ulf Ziemann^{3

4}, Katharina Feil^{3

4}

Affiliations

¹ Department of Neurology and Stroke, Eberhard-Karls University of Tübingen, Tübingen, Germany. annerose.mengel@med.uni-tuebingen.de.
² Hertie Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany. annerose.mengel@med.uni-tuebingen.de.
³ Department of Neurology and Stroke, Eberhard-Karls University of Tübingen, Tübingen, Germany.
⁴ Hertie Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany.
⁵ Department of Neurology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece.
⁶ Department of Neuroradiology, Eberhard-Karls University of Tübingen, Tübingen, Germany.
⁷ Department of Neurology, University Hospital of the Brandenburg Medical School, Rüdersdorf, Germany.

PMID: 39455525
DOI: 10.1007/s12028-024-02146-4

Abstract

Background: Management of intracerebral hemorrhage (ICH) is challenged by limited therapeutic options and a complex relationship between blood pressure (BP) dynamics, especially BP variability (BPV) and ICH outcome.

Methods: In an exploratory analysis of prospectively collected data on consecutive patients with nontraumatic ICH between 2015 and 2020, continuous BP accessed via an arterial line extracted from the Intellispace Critical Care and Anesthesia information system (Philips Healthcare) was analyzed over the first 72 h post admission. Arterial lines were used as part of standard clinical practice in the intensive care, ensuring high fidelity and real-time data essential for acute care settings. BPV was assessed through successive variation (SV), standard deviation (SD), and coefficient of variation using all available BP measurements. Multivariate regression models were applied to evaluate the association between BPV indices and functional outcome at 3 months.

Results: Among 261 patients (mean age 69.6 ± 15.2 years, 47.9% female, median National Institutes of Health Stroke Scale [NIHSS] score 6 [interquartile range 2-12]) analyzed, lower systolic BP upon admission (< 140 mm Hg) and lower systolic BPV were significantly associated with favorable outcome, whereas higher diastolic BPV correlated with improved outcomes. In the multivariate analysis, diastolic BPV (SD, SV) within the first 72 h post admission emerged as an independent predictor of good functional outcome (modified Rankin Scale score < 3; odds ratio 1.123, 95% confidence interval CI 1.008-1.184, p = 0.035), whereas systolic BPV (SD) showed a negative association. Patients with better outcomes also exhibited distinct clinical characteristics, including younger age, lower median NIHSS scores, and less prevalence of anticoagulation therapy upon admission.

Conclusions: This study shows the prognostic value of BPV in the acute phase of ICH. Lower systolic BPV (SD) and higher diastolic BPV (SD, SV) were associated with better functional outcomes, challenging traditional BP management strategies. These findings might help to tailor a personalized BP management in ICH.

Keywords: Blood pressure variability; Functional outcome; Intracerebral hemorrhage; Mortality.