To determine the risk of severe disability or death (SDD) at day-90 among intracerebral hemorrhage (ICH) patients with high in-hospital systolic blood pressure variability (HSPBV). To explore pre-hospital factors associated with experiencing HSPBV during hospitalization.

HSBPV is an emerging marker for poor outcomes among ICH patients. However, evidence for quantification of HSBPV based on routine monitoring of ICH patients is lacking.

Adult, radiologically confirmed primary ICH patients were prospectively enrolled and followed-up for 90 days post-discharge. All routinely collected systolic blood pressure (SBP) values obtained via non-invasive continuous monitoring were recorded for the inpatient stay. Inter and intra-patient SBP variability was quantified using generalized estimating equations. Modified Rankin Scale (mRS) Score of 4 – 6 at day-90 was defined as SDD. Modified Poisson models were fit to determine the risk of day-90 SDD. Logistic regression was used for determining association between pre-hospital characteristics and HSBPV.

A total of 566 patients (mean age: 63.5, females 36.6%, African American 33.4%, Hispanic 27.2%) were included. Overall in-hospital follow-up period was 4,908 days, with median (IQR) per patient follow-up: 8.7 (3-11) days. Over 120,000 SBP readings were analyzed. The mean of inter and intra-patient standard deviation (SD) for SBP was 11.1 and 13.2 mmHg, respectively. A SD of 13.0 was parameterized as a cut-off for HSBPV. Patients with HSBPV had a 17% higher adjusted risk of day-90 SDD (relative risk, 95% CI: 1.17, 1.02-1.35). Older age and female sex were independently associated with HSBPV after controlling for hemorrhage volume, pre-morbid mRS, and Glasgow Coma Scale.

Our data validate prior findings from post-hoc analyses of clinical trials. Furthermore, we demonstrate that quantification of HSBPV is feasible utilizing routinely collected SBP readings. Elderly and female patients may be more likely to demonstrate HSBPV during hospitalization. Further studies incorporating pre-stroke SBPV are needed.