Abstract P455: Time to Blood Pressure Control and Association With Outcomes in Intracerebral Hemorrhage

• Published in: Stroke (1970) Vol. 52; no. Suppl_1
• Main Authors: Chuck, Carlin, Kalagara, Roshini, Abrantes, Tatiana, Doelfel, Savannah, Lin, Nelson F, Zhou, Helen, Dandapani, Hari, Kim, Daniel, Madsen, Tracy, Stretz, Christoph, Mahta, Ali, Wendell, Linda C, Thompson, Bradford B, Furie, Karen L, Reznik, Michael
• Format: Journal Article
• Language: English
• Published: 01.03.2021
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/str.52.suppl_1.P455

Abstract only Background: Urgent blood pressure (BP) control is a mainstay of acute intracerebral hemorrhage (ICH) treatment, but the relationship between time to BP control and clinical outcomes is unclear. Methods: We performed a single-center observational cohort study on consecutive patients with ICH who were hypertensive on hospital arrival over a 2-year period. We defined time-to-BP-control as the time from initial hospital arrival to first BP recorded below our institutionally mandated goal (systolic BP [SBP] <160 mmHg). Using multivariable logistic regression models adjusted for established clinical predictors and time from last-known-well to hospital arrival, we determined associations between time-to-BP-control, hematoma expansion (HE), and unfavorable 3-month outcome (modified Rankin Scale 4-6). We performed additional subgroup analyses in patients with arrival SBP >200 mmHg, hypertensive ICH etiology, and anticoagulation-related ICH. Results: Among 330 patients in our cohort, mean arrival SBP was 191±131 mmHg and mean time-to-BP-control was 2.3±1.5 hours. On univariate analysis, patients without HE had longer time-to-BP-control than those with HE (mean 2.5 vs. 2.1 hours, p=0.02). This was confirmed in multivariable models, where longer time-to-BP-control was associated with a lower likelihood of HE (OR 0.81 per hour, 95% CI 0.66-0.98), and was not associated with 3-month outcome (OR 0.99 per hour, 95% CI 0.81-1.21). Results were similar in subgroup analyses of patients with arrival SBP >200 mmHg and hypertensive ICH etiology. However, in those with anticoagulation-related ICH, longer time-to-BP-control was associated with a higher likelihood of unfavorable 3-month outcome (OR 2.02 per hour, 95% CI 1.13-3.61). Conclusion: Earlier BP control may not improve outcomes in all ICH patients, though some subgroups, such as those with anticoagulation-related ICH, may derive greater benefit from earlier treatment.