PROGNOSTIC VALUE OF ADMISSION BLOOD-PRESSURE IN PATIENTS WITH INTRACEREBRAL HEMORRHAGE - KEIO COOPERATIVE STROKE STUDY

Background and Purpose Patients with acute stroke on admission to the hospital are often found to have high blood pressure. The purpose of t he present study was to investigate the prognostic value of admission blood pressure in patients with acute intracerebral hemorrhage, includ ing putaminal, thalamic, subcortical, cerebellar, and pontine hemorrha ge. Methods A total of 1701 patients with intracerebral hemorrhage of the putamen (n=776; mean+/-SD age, 58+/-14 years), thalamus (n=538; 63 +/-12 years), subcortex (n=153; 61+/-16 years), cerebellum (n=110; 64/-11 years), and pens (n=124; 59+/-13 years) were examined. The mean b lood pressure on admission in patients with a fatal outcome was compar ed with that in patients who survived. Results The mean age in each pa tient group (putaminal, thalamic, subcortical, cerebellar, and pontine hemorrhage) with fatal outcome was older than that with nonfatal outc ome, while ANCOVA indicated no correlation between age and blood press ure on admission or age and volume of hematoma. The mean arterial bloo d pressure on hospital admission was 126.9+/-25.8 mm Hg (+/-SD) in cas es of putaminal, 127.4+/-22.6 mm Hg in thalamic, 116.4+/-20.6 mm Hg in subcortical, 123.5+/-23.9 mm Hg in cerebellar, and 133.0+/-26.0 mm Hg in pontine hemorrhage. The mean blood pressure on admission in patien ts with a fatal outcome among those with putaminal (136.0+/-36.3 mm Hg ) and thalamic (133.2+/-22.1 mm Hg) hemorrhage was significantly highe r than that in those with a nonfatal outcome (123.8+/-20.6 mmHg for pu taminal, 101.6+/-22.5 mmHg for thalamic) (P<.01). No correlation betwe en mean blood pressure and outcome was observed in the patients with s ubcortical (116.5+/-22.2 mmHg for nonfatal, 114.9+/-22.0 mmHg for fata l outcome), cerebellar (125.2+/-22.2 mmHg, 116.9+/-28.8 mmHg), and pon tine (129.9+/-23.8 mmHg, 136.0+/-27.7 mmHg) hemorrhage. The volume of hematoma on admission in patients with fatal outcome with putaminal (5 8.2+/-24.4 mL), thalamic (27.0+/-13.1 mL), subcortical (32.9+/-14.4 mL ), and cerebellar (31.4+/-28.6 mt) hemorrhage was greater than that in those with nonfatal outcome (20.8+/-11.4 mL, 7.1+/-4.8 mL, 18.3+/-10. 6 mL, and 8.1+/-4.2 mL, respectively; P<.01), while no correlation bet ween volume of hematoma and outcome was observed in patients with pont ine hemorrhage. Conclusions The above data suggest that an increased m ean blood pressure and volume of hematoma on admission in putaminal an d thalamic hemorrhage were related to increased mortality, while in pa tients with subcortical, cerebellar, and pontine hemorrhage, the mean blood pressure was not related to the clinical outcome.