Stroke Alert: A Review of Current Clinical Stroke Literature

By Matthew E. Fink, MD,

Professor and Chairman, Department of Neurology, Weill Cornell Medical College, and Neurologist-in-Chief, New York Presbyterian Hospital

Blood Pressure Variability May Predict Poor Outcome After Intracerebral Hemorrhage

Source: Manning L, et al, for the INTERACT2 investigators. Blood pressure variability and outcome after acute intracerebral haemorrhage: A post-hoc analysis of INTERACT2, a randomized controlled trial. Lancet Neurol 2014;13:364-373.

Interact2 was a study of the impact of two blood pressure treatment protocols in patients with spontaneous intracerebral hemorrhage. In that study, two groups were randomly assigned, one group with a target systolic blood pressure < 180 mmHg, and the other group with a target systolic blood pressure of < 140 mmHg. The initial phase of that study showed that there was no difference in neurological outcome, and recommendations were made to target the lower systolic blood pressure values.

This post-hoc analysis of the variability of systolic blood pressure looked at the standard deviation of systolic blood pressure during five measurements taken in the first 24 hours (hyperacute phase) and during 12 measurements taken over days 2-7 (acute phase).

Analysis of the variability of systolic blood pressure indicated that patients who had the highest adjusted quintile of standard deviation of systolic blood pressure in the hyper acute phase, or the acute phase, had an elevated odds ratio (1.41; P = 0167) of poor outcome, determined by major disability at 90 days. The authors suggest that outcomes might be improved if there was a smooth and stable reduction of blood pressure in the first several days after intracerebral hemorrhage, avoiding excessive variability and rebounds of systolic blood pressure.