Abstract Body: Introduction: Elevated blood pressure (BP) is common in acute intracerebral hemorrhage (ICH) and is associated with poor neurological outcomes. However, about a quarter of patients present with normal BP, and this group is understudied. We aimed to evaluate the association between patterns of BP course and clinical outcomes.
Methods: We conducted a retrospective cohort study using prospectively collected data from consecutive acute ICH patients who were scanned within 6 hours of symptom onset over a 7-year period. Patients underwent 24-hour noninvasive BP monitoring, and clinical outcomes were recorded at 24 hours. Patients were treated under a rapid (target achievement ≤60 minutes), intensive (target SBP <140 mmHg), and sustained (target stability for 24 hours) BP protocol when systolic BP (SBP) was ≥150 mmHg. Patterns of BP course were classified as Early High when SBP was ≥150 mmHg on admission, Late High when SBP was <150 mmHg on admission but increased to ≥150 mmHg within the first 24 hours, requiring treatment, and Steady Low when SBP spontaneously remained <150 mmHg from admission to the 24-hour follow-up. The primary outcome was early neurologic deterioration (END), defined as an increase in NIHSS score by ≥4 points or death within 24 hours. Multiple logistic regression analysis was adjusted for age, sex, anticoagulation, onset-to-imaging time, ICH volume, and intraventricular extension.
Results: We included 424 patients (mean age 72.1±13.7 years, 263 [62.0%] male). At baseline, mean SBP was 168.2±28.3 mmHg, median onset-to-imaging time 124 (80–218) minutes, and median ICH volume 14.9 (5.8–39.3) mL. The distribution of BP patterns was as follows: Early High in 335 (79.0%) patients, Late High in 65 (15.3%), and Steady Low in 24 (5.7%). END occurred in 147 (34.7%) patients. There was a steady increase in the frequency of END across BP patterns: Steady Low 12.5% (3/24), Late High 26.2% (17/65), and Early High 37.3% (127/335) (P=0.012, Figure 1). The occurrence of SBP ≥150 mmHg (Early or Late High) was independently associated with END (aOR 7.6, 95% CI 1.9–53.3).
Conclusions: Most acute ICH patients experienced an SBP ≥150 mmHg within 24 hours, even among those who initially presented with lower BP. Patients who initially had SBP <150 mmHg but later experienced an increase to ≥150 mmHg were at a significantly higher risk of END. Overall, BP elevation, regardless of initial BP levels, is a strong predictor of END in acute ICH patients.