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Association Between Hyperacute Blood Pressure Variability and Hematoma Expansion After Intracerebral Hemorrhage: Secondary Analysis of the FAST-MAG Database

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Abstract

Background

Blood pressure variability (BPV) has emerged as a significant factor associated with clinical outcomes after intracerebral hemorrhage (ICH). Although hematoma expansion (HE) is associated with clinical outcomes, the relationship between BPV that encompasses prehospital data and HE is unknown. We hypothesized that BPV was positively associated with HE.

Methods

We analyzed 268 patients with primary ICH enrolled in the National Institutes of Health-funded Field Administration of Stroke Therapy-Magnesium (FAST-MAG) study who received head computed tomography or magnetic resonance imaging on arrival to the emergency department (ED) and repeat imaging within 6–48 h. BPV was calculated by standard deviation (SD) and coefficient of variation (CV) from prehospital data as well as systolic blood pressure (SBP) measurements taken on ED arrival, 15 min post antihypertensive infusion start, 1 h post maintenance infusion start, and 4 h after ED arrival. HE was defined by hematoma volume expansion increase > 6 mL or by 33%. Univariate logistic regression was used for presence of HE in quintiles of SD and CV of SBP for demographics and clinical characteristics.

Results

Of the 268 patients analyzed from the FAST-MAG study, 116 (43%) had HE. Proportions of patients with HE were not statistically significant in the higher quintiles of the SD and CV of SBP for either the hyperacute or the acute period. Presence of HE was significantly more common in patients on anticoagulation.

Conclusions

Higher BPV was not found to be associated with occurrence of HE in the hyperacute or the acute period of spontaneous ICH. Further study is needed to determine the relationship.

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Funding

This work was supported by grants UL1TR001855 and UL1TR000130 from the National Center for Advancing Translational Science of the U.S. National Institutes of Health (to MW). This work was also supported by grant UL1TR001855 from the Southern California Clinical and Translational Science Institute (to RAP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Southern California Clinical and Translational Science Institute.

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Authors and Affiliations

  1. Department of Neurology, Keck School of Medicine, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA

    Daniel M. Oh, Roy A. Poblete & Nerses Sanossian

  2. Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Kristina Shkirkova

  3. Department of Neurology, Kangbuk Samsung Hospital, Seoul, Republic of Korea

    Pil-Wook Chung

  4. Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA

    Jeffrey L. Saver & David S. Liebeskind

  5. Department of Emergency Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Sidney Starkman

  6. Department of Neurology, Stanford University, Palo Alto, CA, USA

    Scott Hamilton

  7. Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Melissa Wilson

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  1. Daniel M. Oh
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Contributions

DMO writing manuscript draft, critical revision, interpretation of data. KS key statistical analysis, study design, statistical methodology, data analysis. RAP writing manuscript, review and editing, critical revision, interpretation of data. PWC conducted investigation for evidence analysis, provided analytic resources. JLS study design, methodology, and project administration in the original study. SS substantial contribution to conception, study design, and methodology in the original study. DSL substantial contribution to conception, study design, and methodology in the original study. SH substantial contribution to conception, statistical methodology, and analysis in the original study. MW performed statistical analysis and writing. NS principal investigator, study conceptualization and design, critical manuscript writing, project administration and supervision.

Corresponding author

Correspondence to Daniel M. Oh.

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Conflict of interest

No financial disclosures for DMO, KS, PWC, JLS, SS, SH, and NS. DSL: Consultant as Imaging Core Lab to Cerenovus, Genentech, Medtronic, Stryker, and Rapid Medical.

Ethical approval/informed consent

Informed consent and full institutional review board approval was not required. The secondary analysis falls under the exempt criteria of 45 CFR 46.101 (b) (4) because the study involved existing data, documents, and diagnostic records recorded in an anonymous manner such that the study participants cannot be identified neither directly nor through any identifiers.

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Oh, D.M., Shkirkova, K., Poblete, R.A. et al. Association Between Hyperacute Blood Pressure Variability and Hematoma Expansion After Intracerebral Hemorrhage: Secondary Analysis of the FAST-MAG Database. Neurocrit Care 38, 356–364 (2023). https://doi.org/10.1007/s12028-022-01657-2

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