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Arrival blood pressure in hypertensive and non-hypertensive spontaneous intracerebral hemorrhage.

Publication ,  Journal Article
Reznik, ME; Fakhri, N; Moody, S; Murray, K; Costa, S; Yaghi, S; Schrag, M; Madsen, TE; Burton, TM; Cutting, S; Mahta, A; Wendell, LC; Rao, SS ...
Published in: J Neurol Sci
September 15, 2020

BACKGROUND AND PURPOSE: Hypertension is a known risk factor for intracerebral hemorrhage (ICH), but it is unclear whether blood pressure (BP) at hospital arrival can be used to distinguish hypertensive ICH from non-hypertensive etiologies. PATIENTS AND METHODS: We performed a single-center cohort study using data from consecutive ICH patients over 12 months. ICH characteristics including etiology were prospectively adjudicated by two attending neurologists. Using adjusted linear regression models, we compared first recorded systolic BPs (SBP) and mean arterial pressures (MAP) in patients with hypertensive vs. other ICH etiologies. We then used area under the ROC curve (AUC) analysis to determine the accuracy of admission BP in differentiating between hypertensive and non-hypertensive ICH. RESULTS: Of 311 patients in our cohort (mean age 70.6 ± 15.6, 50% male, 83% white), the most frequent ICH etiologies were hypertension (50%) and cerebral amyloid angiopathy (CAA; 22%). Mean SBP and MAP for patients with hypertensive ICH was 175.1 ± 32.9 mmHg and 120.4 ± 22.9 mmHg, respectively, compared to 156.4 ± 28.0 mmHg and 109.6 ± 20.3 mmHg in non-hypertensive ICH (p < .001). Adjusted models showed that hypertensive ICH patients had higher BPs than those with CAA (mean SBP difference 10.7 mmHg [95% CI 0.8-20.5]; mean MAP difference 8.1 mmHg [1.1-15.0]) and especially patients with other non-CAA causes (mean SBP difference 23.9 mmHg [15.3-32.4]; mean MAP difference 14.5 mmHg [8.5-20.6]). However, on a patient-level, arrival BP did not reliably discriminate between hypertensive and non-hypertensive etiologies (AUC 0.660 [0.599-0.720]). CONCLUSIONS: Arrival BP differs between hypertensive and non-hypertensive ICH but should not be used as a primary determinant of etiology, as hypertension may be implicated in various subtypes of ICH.

Duke Scholars

Published In

J Neurol Sci

DOI

EISSN

1878-5883

Publication Date

September 15, 2020

Volume

416

Start / End Page

117000

Location

Netherlands

Related Subject Headings

  • Middle Aged
  • Male
  • Intracranial Hemorrhage, Hypertensive
  • Hypertension
  • Humans
  • Female
  • Cohort Studies
  • Cerebral Hemorrhage
  • Cerebral Amyloid Angiopathy
  • Blood Pressure
 

Citation

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Reznik, M. E., Fakhri, N., Moody, S., Murray, K., Costa, S., Yaghi, S., … Mac Grory, B. (2020). Arrival blood pressure in hypertensive and non-hypertensive spontaneous intracerebral hemorrhage. J Neurol Sci, 416, 117000. https://doi.org/10.1016/j.jns.2020.117000
Reznik, Michael E., Nasir Fakhri, Scott Moody, Kayleigh Murray, Samantha Costa, Shadi Yaghi, Matthew Schrag, et al. “Arrival blood pressure in hypertensive and non-hypertensive spontaneous intracerebral hemorrhage.J Neurol Sci 416 (September 15, 2020): 117000. https://doi.org/10.1016/j.jns.2020.117000.
Reznik ME, Fakhri N, Moody S, Murray K, Costa S, Yaghi S, et al. Arrival blood pressure in hypertensive and non-hypertensive spontaneous intracerebral hemorrhage. J Neurol Sci. 2020 Sep 15;416:117000.
Reznik, Michael E., et al. “Arrival blood pressure in hypertensive and non-hypertensive spontaneous intracerebral hemorrhage.J Neurol Sci, vol. 416, Sept. 2020, p. 117000. Pubmed, doi:10.1016/j.jns.2020.117000.
Reznik ME, Fakhri N, Moody S, Murray K, Costa S, Yaghi S, Schrag M, Madsen TE, Burton TM, Cutting S, Mahta A, Wendell LC, Thompson BB, Rao SS, Stretz C, Furie KL, Mac Grory B. Arrival blood pressure in hypertensive and non-hypertensive spontaneous intracerebral hemorrhage. J Neurol Sci. 2020 Sep 15;416:117000.
Journal cover image

Published In

J Neurol Sci

DOI

EISSN

1878-5883

Publication Date

September 15, 2020

Volume

416

Start / End Page

117000

Location

Netherlands

Related Subject Headings

  • Middle Aged
  • Male
  • Intracranial Hemorrhage, Hypertensive
  • Hypertension
  • Humans
  • Female
  • Cohort Studies
  • Cerebral Hemorrhage
  • Cerebral Amyloid Angiopathy
  • Blood Pressure