Cumulative Dose of Hypertension Predicts Outcome in Intracranial Hemorrhage Better Than American Heart Association Guidelines
2007; Wiley; Volume: 14; Issue: 8 Linguagem: Inglês
10.1111/j.1553-2712.2007.tb01863.x
ISSN1553-2712
AutoresChristopher W. Barton, J. Claude Hemphill,
Tópico(s)Traumatic Brain Injury and Neurovascular Disturbances
ResumoAcademic Emergency MedicineVolume 14, Issue 8 p. 695-701 Free Access Cumulative Dose of Hypertension Predicts Outcome in Intracranial Hemorrhage Better Than American Heart Association Guidelines Christopher W. Barton MD, Corresponding Author Christopher W. Barton MD Departments of Medicine Contact for correspondence and reprints: Christopher W. Barton, MD (Email: cbarton@sfghed.ucsf.edu).Search for more papers by this authorJ. Claude Hemphill MD, J. Claude Hemphill MD Neurology (JCH), University of California, San Francisco, San Francisco, CASearch for more papers by this author Christopher W. Barton MD, Corresponding Author Christopher W. Barton MD Departments of Medicine Contact for correspondence and reprints: Christopher W. Barton, MD (Email: cbarton@sfghed.ucsf.edu).Search for more papers by this authorJ. Claude Hemphill MD, J. Claude Hemphill MD Neurology (JCH), University of California, San Francisco, San Francisco, CASearch for more papers by this author First published: 28 June 2008 https://doi.org/10.1197/j.aem.2007.03.1358Citations: 7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract BackgroundHypertension is common after intracranial hemorrhage (ICH) and may be associated with higher mortality and adverse neurologic outcome. The American Heart Association recommends that blood pressure be maintained at a mean arterial pressure (MAP) less than 130 mm Hg to prevent secondary brain injury. ObjectivesTo prospectively evaluate whether a new method of assessing hypertension in ICH more accurately identifies patients at risk for adverse outcomes. MethodsThe authors prospectively studied all patients presenting to two University of California, San Francisco hospitals with acute ICH from June 1, 2001, to May 31, 2004. Factors related to acute hospitalization were recorded in a database, including all charted vital signs for the first 15 days. Patients were followed up for one year, with their modified Rankin Scale (mRS) score at 12 months as primary outcome. Hypertension dose was determined as the area under the curve between patient MAP and a cut point of 110 mm Hg while in the emergency department (ED). The dose was adjusted for time spent in the ED (dose/timeed [d/ted]). Hypertension dose was divided into four categories (none, and progressive tertiles). Multivariate logistic regression was used to calculate the odds ratio for adverse mRS by tertiles of d/ted. ResultsA total of 237 subjects with an ED average (±SD) length of stay of 3.42 (±3.7) hours were enrolled. In a multivariate logistic regression model controlling for the effects of age, volume of hemorrhage, presence of intraventricular hemorrhage, race, and preexisting hypertension, there was a 4.7- and 6.1-fold greater likelihood of an adverse neurologic outcome (by mRS) at one and 12 months, respectively, in the highest d/ted tertile relative to the referent group without hypertension. ConclusionsHypertension after acute ICH is associated with adverse neurologic outcome. The dose of hypertension may more accurately identify patients at risk for adverse outcomes than the American Heart Association guidelines and may lead to better outcomes if treated when identified in this manner. 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