Impacto de los cambios y el curso de la presión arterial mediante monitorización intensiva en la evolución clínica y radiológica tras una hemorragia intracerebral aguda

Abstract

Background Due to both poor outcome and high mortality rates associated with intracerebral hemorrhage (ICH), and also the absence of proven treatments, it is rather important to identify risk factors related to hematoma growth (HG) and clinical and functional outcome. Nevertheless, the relation of higher blodd pressure (BP) with the risk of HG has not been clearly demonstrated yet. More frequent BP measurements during the acute period as well as the study of other parameters that better reflect changes and course of BP may be needed. Objectives 1) To investigate the impact of BP changes and course on HG in acute ICH. 2) To evaluate the impact of BP changes and course on clinical outcome in acute ICH. 3) To investigate the impact of BP changes and course on HG in the spot-sign-positive group. 4)To determinate the association of potential systlic blood pressure (SBP) thresholds with HG and clinical outcome in patients with acute ICH. 5) To determinate efficacy of intensiva BP monitoring compared with non-intensive BP monitoring at clinical outcome in acute HIC. Methods We prospectively studied consecutive patients with primary supratentorial ICH presenting within 6 hours from symptoms onset. CT scan was recorded at baseline and at 24 hours. An automatic non-invasive BP monitoring each 15 minutes during the first 24 hours was performed. We recorded HG at 24 hours, early neurological deterioration, 3-month mortality and poor long-term outcome. Results 1) SBP 180- load independently predicted HG (OR 1.05, 95 % CI 1.010-1.097, P=0.016). 2) Both SBP 180-load (OR 1.04, 95 % CI 1.001-1.076, P=0.042) and SBP variability (OR 1.2, 95 % CI 1.047-1-380, P=0.09) independently predicted early neurological deterioration (END). 3) Higher máximum BP increases from baseline and higher Systolic BP (SBP) and Media BP (MBP) loads were significantly related to HG in the spot-sign-negative group. 4) SPB 170, 180, 190 and 200 loads were significantly correlated with the amount of both absolute anda relative hematoma enlargement at 24 hours. SBP 170 load was related to HG and END, while SBP 160 load was associated wtih mortality at 24 hours.5) Patientes with poor SBP in the first 6 hours detected in intensive BP monitoring experienced higher rate of END (50%, P=0.02). Similarly, poor SBP control within 24h was associated wtih HG (P=0.024) and poor functional outcome (P=0.032) according intensive BP monitoring. Conclusions 1) SBP 180-load independently predicts HG. 2) Both SBP 180-load and SBP variability predict END. 3) The presence of spot-sign-positive in angio-CT does not seem to influence the relation between BP and CH. 4)SBP lowering to at least less tan 160 mmHg threshold may be needed to minimize the deleteious effect of high SBP on 24-hours outcome. 5) Intensive BP monitoring improves the detection of patients in risk of CH and DNP compared with non-intensive BP monitoring.

Date of Award	22 Sept 2017
Original language	Spanish
Supervisor	David Rodríguez-Luna (Director), Carlos Molina Cateriano (Director), Jose Alvarez Sabin (Director) & Jaume Alijotas Reig (Director)