Influence of Time to Achieve Target Systolic Blood Pressure on Outcome After Intracerebral Hemorrhage: The Blood Pressure in Acute Stroke Collaboration

Wang, Xia; Yang, Jie; Moullaali, Tom J; Sandset, Else Charlotte; Woodhouse, Lisa J; Law, Zhe Kang; Arima, Hisatomi; Butcher, Kenneth S; Delcourt, Candice; Mbbs, Leon Edwards; Gupta, Salil; Jiang, Wen; Koch, Sebastian; Potter, John; Qureshi, Adnan I; Robinson, Thompson G; Salman, Rustam Al-Shahi; Saver, Jeffrey L; Sprigg, Nikola; Wardlaw, Joanna; Anderson, Craig S; Sakamoto, Yuki; Bath, Philip M; Chalmers, John

Abstract

OBJECTIVE:
To investigate whether an earlier time to achieving and maintaining systolic blood pressure (SBP) at 120 to 140 mm Hg is associated with favorable outcomes in a cohort of patients with acute intracerebral hemorrhage.

METHODS:
We pooled individual patient data from randomized controlled trials registered in the Blood Pressure in Acute Stroke Collaboration. Time was defined as time form symptom onset plus the time (hour) to first achieve and subsequently maintain SBP at 120 to 140 mm Hg over 24 hours. The primary outcome was functional status measured by the modified Rankin Scale at 90 to 180 days. A generalized linear mixed models was used, with adjustment for covariables and trial as a random effect.

RESULTS:
A total of 5761 patients (mean age, 64.0 [SD, 13.0], 2120 [36.8%] females) were included in analyses. Earlier SBP control was associated with better functional outcomes (modified Rankin Scale score, 3–6; odds ratio, 0.98 [95% CI, 0.97–0.99]) and a significant lower risk of hematoma expansion (0.98, 0.96–1.00). This association was stronger in patients with bigger baseline hematoma volume (>10 mL) compared with those with baseline hematoma volume ≤10 mL (0.006 for interaction). Earlier SBP control was not associated with cardiac or renal adverse events.

CONCLUSIONS:
Our study confirms a clear time relation between early versus later SBP control (120–140 mm Hg) and outcomes in the one-third of patients with intracerebral hemorrhage who attained sustained SBP levels within this range. These data provide further support for the value of early recognition, rapid transport, and prompt initiation of treatment of patients with intracerebral hemorrhage.

Citation

Wang, X., Yang, J., Moullaali, T. J., Sandset, E. C., Woodhouse, L. J., Law, Z. K., Arima, H., Butcher, K. S., Delcourt, C., Mbbs, L. E., Gupta, S., Jiang, W., Koch, S., Potter, J., Qureshi, A. I., Robinson, T. G., Salman, R. A.-S., Saver, J. L., Sprigg, N., Wardlaw, J., …Chalmers, J. (2024). Influence of Time to Achieve Target Systolic Blood Pressure on Outcome After Intracerebral Hemorrhage: The Blood Pressure in Acute Stroke Collaboration. Stroke, 55(4), 849-855. https://doi.org/10.1161/STROKEAHA.123.044358

• Journal Article Type: Article
• Acceptance Date: Jan 17, 2024
• Online Publication Date: Feb 27, 2024
• Publication Date: 2024-04
• Deposit Date: Apr 4, 2024
• Publicly Available Date: Aug 28, 2024
• Journal: Stroke
• Print ISSN: 0039-2499
• Electronic ISSN: 1524-4628
• Publisher: American Heart Association
• Peer Reviewed: Peer Reviewed
• Volume: 55
• Issue: 4
• Pages: 849-855
• DOI: https://doi.org/10.1161/STROKEAHA.123.044358
• Public URL: https://nottingham-repository.worktribe.com/output/29836683
• Publisher URL: https://www.ahajournals.org/doi/abs/10.1161/STROKEAHA.123.044358