Rate of 24-hour blood pressure decline and mortality after spontaneous intracerebral hemorrhage: A retrospective analysis with a random effects regression model

Objective: To study the effect of decline in blood pressure on mortality in patients with spontaneous intracerebral hemorrhage (ICH). Design: Retrospective chart review. Setting: University-affiliated teaching hospital. Patients: Consecutive patients admitted with spontaneous ICH over a 3-year period. Measures: Blood pressure recordings were obtained from the first 24 hrs. Pa tients (n = 105) with more than five blood pressure recordings and on avera ge greater than one measurement per 2 hrs were included (mean measurements per patient = 20.3). Mean arterial pressure (MAP) recordings over the first 24 hrs after presentation were regressed on time for each patient. Each pa tient's MAP was calculated as a slope (change mm Hg/hr). We performed logis tic regression analyses to determine the effect of MAP slope on mortality a nd functional outcome, adjusting for other predictive factors including Gla sgow Coma Scale (GCS) score and hematoma volume. The effect of MAP slope on mortality was also evaluated in subsets of patients based on age, gender, initial GCS score, initial MAP, treatment status, hematoma volume, and pres ence of ventricular blood. Main Results: Mean slope of change in MAP was -2.0 mm Hg/hr (+/- 1.9, range -8.5 to +0.6). The slope of MAP (faster rate of decline) within the first: 24 hrs was significantly associated with higher mortality (p = .04), indep endent of initial GCS scare and hematoma volume. In subgroup analyses, MAP slope was significantly associated with mortality in men (p = .08), patient s with hematoma Volume < 50 mm(3) (p = .08), initial MAP less than or equal to 146 mm Hg (p = .006), and those with initial GCS score greater than or equal to 10 (p = .07). MAP slope did not predict functional outcome among s urvivors. Conclusions: A rapid decline in MAP within 24 hrs after presentation is ind ependently associated with increased mortality in patients with ICH. A larg e, prospective, randomized trial is required to confirm these findings.