TY - JOUR
T1 - High in-hospital blood pressure variability and severe disability or death in primary intracerebral hemorrhage patients
AU - Meeks, Jennifer R.
AU - Bambhroliya, Arvind B.
AU - Meyer, Elizabeth G.
AU - Slaughter, Kristen B.
AU - Fraher, Christopher J.
AU - Sharrief, Anjail Z.
AU - Bowry, Ritvij
AU - Ahmed, Wamda O.
AU - Tyson, Jon E.
AU - Miller, Charles C.
AU - Warach, Steve
AU - Khan, Babar A.
AU - McCullough, Louise D.
AU - Savitz, Sean I.
AU - Vahidy, Farhaan S.
N1 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work is funded by the Texas State Legislature via the Lone Star Stroke Research Consortium.
Funding Information:
Neither the Texas State Legislature nor the Lone Star Stroke Research Consortium influenced study design, data collection and analysis, data interpretation or writing of this manuscript. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the State of Texas. The authors acknowledge the support provided by the Biostatistics/Epidemiology/ Research Design (BERD) component of the Center for Clinical and Translational Sciences (CCTS) for this project. CCTS is mainly funded by a grant (UL1 TR000371) from the National Center for Advancing Translational Sciences (NCATS), awarded to University of Texas Health Science Center at Houston. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCATS.
Publisher Copyright:
© 2019 World Stroke Organization.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - Objective: To quantify in-hospital systolic blood pressure variability among patients with intracerebral hemorrhage, determine the association between high systolic blood pressure variability (HSBPV) and 90-day severe disability or death, and examine the association between pre-hospital factors and HSBPV. Methods: Adult, radiologically confirmed, intracerebral hemorrhage patients enrolled in a multi-site cohort were included. Using a semi-automated algorithm, systolic blood pressure values recorded from routine non-invasive systolic blood pressure monitoring in critical and acute care settings were extracted for the duration of hospitalization. Inter and intra-patient systolic blood pressure variability was quantified using generalized estimating equation methods. Modified Poisson and logistic regression models were fit to determine the association between HSBPV and 90-day severe disability or death and between pre-hospital characteristics and HSBPV, respectively. Results: A total of 566 patients managed at four certified stroke centers were included. Over 120,000 systolic blood pressure readings were analyzed, and a standard deviation (SD) of 13.0 was parameterized as a cut-off point to categorize HSBPV. Patients with HSBPV had a greater risk of 90-day severe disability or death (relative risk: 1.20, 95% confidence interval: 1.04–1.39), after controlling for age, pre-morbid functional status, and other disease severity measures. Greater likelihood of in-hospital HSBPV was independently observed in elderly, female patients, and in patients with high admission systolic blood pressure. Conclusion: Quantification of HSBPV is feasible utilizing routinely collected systolic blood pressure readings, and a singular cut-off parameter for systolic blood pressure variability demonstrated association with 90-day severe disability or death. Elderly, female, and patients with high admission systolic blood pressure may be more likely to demonstrate HSBPV during hospitalization.
AB - Objective: To quantify in-hospital systolic blood pressure variability among patients with intracerebral hemorrhage, determine the association between high systolic blood pressure variability (HSBPV) and 90-day severe disability or death, and examine the association between pre-hospital factors and HSBPV. Methods: Adult, radiologically confirmed, intracerebral hemorrhage patients enrolled in a multi-site cohort were included. Using a semi-automated algorithm, systolic blood pressure values recorded from routine non-invasive systolic blood pressure monitoring in critical and acute care settings were extracted for the duration of hospitalization. Inter and intra-patient systolic blood pressure variability was quantified using generalized estimating equation methods. Modified Poisson and logistic regression models were fit to determine the association between HSBPV and 90-day severe disability or death and between pre-hospital characteristics and HSBPV, respectively. Results: A total of 566 patients managed at four certified stroke centers were included. Over 120,000 systolic blood pressure readings were analyzed, and a standard deviation (SD) of 13.0 was parameterized as a cut-off point to categorize HSBPV. Patients with HSBPV had a greater risk of 90-day severe disability or death (relative risk: 1.20, 95% confidence interval: 1.04–1.39), after controlling for age, pre-morbid functional status, and other disease severity measures. Greater likelihood of in-hospital HSBPV was independently observed in elderly, female patients, and in patients with high admission systolic blood pressure. Conclusion: Quantification of HSBPV is feasible utilizing routinely collected systolic blood pressure readings, and a singular cut-off parameter for systolic blood pressure variability demonstrated association with 90-day severe disability or death. Elderly, female, and patients with high admission systolic blood pressure may be more likely to demonstrate HSBPV during hospitalization.
KW - Intracerebral hemorrhage
KW - cerebrovascular disease/stroke
KW - high blood pressure
KW - hypertension
KW - hypertension
KW - intracranial hemorrhage
KW - outcome
KW - quality and outcomes
KW - subject terms
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U2 - 10.1177/1747493019827763
DO - 10.1177/1747493019827763
M3 - Article
C2 - 30681042
AN - SCOPUS:85060623166
SN - 1747-4930
VL - 14
SP - 987
EP - 995
JO - International Journal of Stroke
JF - International Journal of Stroke
IS - 9
ER -