Abstract Details

Title Blood Pressure at Hospital Arrival Does Not Reliably Distinguish Hypertensive Intracerebral Hemorrhage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-002

Objective Determine whether arrival blood pressure (BP) should be used to distinguish intracerebral hemorrhage (ICH) etiology.

Background Hypertension is a known risk factor for ICH, but it is unclear whether BP elevation at hospital arrival can reliably distinguish hypertensive ICH from non-hypertensive etiologies.

Design/Methods We performed a retrospective single-center cohort study using data from consecutive ICH patients from February-June 2018. ICH features including presumed etiology were prospectively adjudicated by two attending neurologists. We compared patients’ first recorded systolic BP (SBP) and mean arterial pressure (MAP) stratified by hypertensive vs. non-hypertensive ICH etiology, and adjusted for demographics and initial arrival location using linear regression. In a sensitivity analysis, we used ICH location rather than etiology given potential subjectivity in adjudication.

Results There were 110 ICH patients in our cohort (mean age 69.1 [SD 17.7], 55% male, median ICH score 1.5 [IQR 1-2]). The most frequent etiologies were hypertension (58%), cerebral amyloid angiopathy (19%), and vascular lesions (6%); the most frequent locations were deep (43%), lobar (37%), and infratentorial (14%). Mean SBP and MAP for patients with hypertensive ICH was 158.8 (SD 29.7) and 109.0 (SD 18.3), compared to 157.1 (SD 33.4) and 108.2 (SD 21.2) in non-hypertensive ICH (p=0.78; p=0.82). Adjusted models showed that, relative to hypertensive ICH, patients with non-hypertensive ICH had similar arrival BP (mean SBP and MAP difference [95% CI], -0.2 [-12.3–11.8] and -0.8 [-8.4–6.8]). In a sensitivity analysis, we found that lobar and infratentorial ICH had similar arrival BP relative to deep ICH (mean SBP and MAP difference [95% CI], 2.1 [-11.1–15.3] and 0.2 [-8.3–8.6] for lobar ICH; 6.5 [-12.0–25.0] and 3.8 [-8.0–15.6] for infratentorial ICH).

Conclusions

Arrival BP should not be used as a primary determinant of likely ICH etiology, as hypertension may be implicated in various subtypes of ICH.

Authors/Disclosures
Nasir Fakhri, MD (University of Louisville Hospital) PRESENTER	No disclosure on file
Scott Moody	No disclosure on file
	No disclosure on file
	No disclosure on file
Shadi Yaghi, MD (Hackensack Meridian Health)	Dr. Yaghi has nothing to disclose.
Tina M. Burton, MD	Dr. Burton has nothing to disclose.
Shawna M. Cutting, MD, FAAN	The institution of Dr. Cutting has received research support from Genentech.
Ali Mahta, MD (Brown University)	Dr. Mahta has received research support from Brown University Health.
Linda C. Wendell, MD, FAAN (Mount Auburn Hospital)	Dr. Wendell has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. An immediate family member of Dr. Wendell has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. Dr. Wendell has stock in Apple. An immediate family member of Dr. Wendell has stock in Apple.
Bradford B. Thompson, MD (St. Elizabeth’s Medical Center)	Dr. Thompson has nothing to disclose.
Shyam S. Rao, MD (Rhode Island Hospital, Brown University)	No disclosure on file
	No disclosure on file
Karen L. Furie, MD (RIH/Alpert Medical School of Brown Univ)	The institution of Dr. Furie has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen/BMS. Dr. Furie has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for BMJ/JNNP. The institution of Dr. Furie has received research support from NINDS.
Brian Mac Grory, MB BCh BAO (Duke University School of Medicine)	An immediate family member of Dr. Mac Grory has received personal compensation for serving as an employee of Sanofi. Dr. Mac Grory has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke. The institution of Dr. Mac Grory has received research support from National Institutes of Health. The institution of Dr. Mac Grory has received research support from American Heart Association.
Michael Reznik, MD (Rhode Island Hospital)	Dr. Reznik has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Morrison Mahoney. The institution of Dr. Reznik has received research support from NIDUS.

��ɫ��

��ɫ��