PROGNOSTIC VALUE AND DETERMINANTS OF FIRST-DAY MEAN ARTERIAL-PRESSUREIN SPONTANEOUS SUPRATENTORIAL INTRACEREBRAL HEMORRHAGE

Background and Purpose The onset of spontaneous intracerebral hemorrha ge (ICH) is often accompanied by transient blood pressure (BP) elevati on. The prognostic value and the determinants of this BP reaction have not entirely been solved, and the present study was focused on these questions. Methods From 1985 to 1991 in Central Finland (population, 2 46 000), a total of 425 patients had first-ever ICH verified by CT or necropsy. The hematoma was supratentorial in 337 patients. Of the 306 patients with supratentorial ICH who had CT, 282 had the BP measured a t least once within 24 hours of onset, and they formed the study popul ation. The case notes and CT films were reviewed, and mean arterial pr essure (MAP) was calculated from the highest BP reading. Results The f atality rate was high; 43% of the patients were dead within 28 days of onset. Six independent predictors of the 28-day survival were identif ied by multiple logistic regression; these predictors were consciousne ss on admission, first-day MAP, subarachnoid spread of the bleed, late ral shift of hemispheral midline structures, admission blood glucose, and vomiting. The MAPs varied between 66.7 and 203.3 mm Hg, and the cu toff points of the MAP quartiles were 118, 132, and 145 mm Hg. Patient s in the first three MAP quartiles had relatively fair outcome, with 7 1%, 65%, and 60%, respectively, alive 28 days after onset. This was in sharp contrast to the fourth quartile, with only 33% surviving the fi rst 28 days (log-rank, P<.0001 to P=.0010). Patients unconscious/comat ose on admission had significantly higher MAPs than did those who were alert or somnolent/disoriented (ANOVA, P=.0079). However, at all leve ls of consciousness, the 28-day fatality rate Increased from the first to the fourth MAP quartile: 69% in the alert, 186% in the somnolent/d isoriented, and 45% in the unconscious/comatose patients. Stepwise mul tiple regression analysis gave four independent predictors of the firs t-day MAP: hypertension, age (in an inverse fashion), admission blood glucose, and hematoma volume. Conclusions The most important predictor of the 28-day survival was the level of consciousness on admission, f ollowed by first-day MAP. Hypertension was the most important predicto r of the first-day MAP, followed by age, which had an inverse effect o n the MAP level. At all levels of consciousness, high first-day MAP (e specially if >145 mm Hg) worsened the 28-day survival rate.