Document Detail

Cumulative dose of hypertension predicts outcome in intracranial hemorrhage better than American Heart Association guidelines.
MedLine Citation:
PMID:  17656606     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Hypertension 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. OBJECTIVES: To prospectively evaluate whether a new method of assessing hypertension in ICH more accurately identifies patients at risk for adverse outcomes. METHODS: The 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/time(ed) [d/t(ed)]). 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/t(ed). RESULTS: A 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/t(ed) tertile relative to the referent group without hypertension. CONCLUSIONS: Hypertension 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.
Christopher W Barton; J Claude Hemphill
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Academic emergency medicine : official journal of the Society for Academic Emergency Medicine     Volume:  14     ISSN:  1553-2712     ISO Abbreviation:  Acad Emerg Med     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-07-27     Completed Date:  2007-09-11     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9418450     Medline TA:  Acad Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  695-701     Citation Subset:  IM    
Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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MeSH Terms
Age Distribution
Aged, 80 and over
American Heart Association
Antihypertensive Agents / therapeutic use*
Blood Pressure Determination
Cohort Studies
Emergency Service, Hospital
Follow-Up Studies
Hypertension / diagnosis,  drug therapy*,  epidemiology*
Intracranial Hemorrhages / diagnosis*,  mortality*,  therapy
Logistic Models
Middle Aged
Monitoring, Physiologic / methods
Multivariate Analysis
Practice Guidelines as Topic
Predictive Value of Tests
Prospective Studies
Risk Assessment
Severity of Illness Index
Sex Distribution
Survival Analysis
Grant Support
Reg. No./Substance:
0/Antihypertensive Agents
Comment In:
Acad Emerg Med. 2007 Aug;14(8):740-2   [PMID:  17656609 ]

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