System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Ahead of print

PubMed: 40501043 DOI: 10.1177/23969873251343495

Impact of white matter lesions on associations between prehospital blood pressure and outcomes in spontaneous intracerebral hemorrhage.

Eur Stroke J

Authors: Kristin Tveitan Larsen, Silje Holt Jahr, Maiken Nordahl Selseth, Trine Lied-Herland, Vigdis Hillestad, Hege Ihle-Hansen, Else Charlotte Sandset, Ole Morten Rønning, Espen Saxhaug Kristoffersen

Affiliations

  • Department of Neurology, Akershus University Hospital, Lørenskog, Norway. Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway. Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
  • Department of Neurology, Akershus University Hospital, Lørenskog, Norway. Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
  • Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway.
  • Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway.
  • Department of Acute Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway. Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Norway.
  • Department of Neurology, Oslo University Hospital, Oslo, Norway. The Norwegian Air Ambulance Foundation, Oslo, Norway.
  • Department of Neurology, Akershus University Hospital, Lørenskog, Norway. Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.

Abstract

INTRODUCTION

There are concerns about the safety of intensive blood pressure (BP) lowering in intracerebral hemorrhage (ICH) patients with white matter lesions (WML). We explored the impact of WML on associations between i) prehospital BP, and ii) BP change, and outcomes in acute, spontaneous ICH.

PATIENTS AND METHODS

This retrospective study included consecutive patients with acute spontaneous ICH, admitted 2011-2020. WML on non-contrast computed tomography were categorized as none-to-mild (0-1) or moderate-to-severe (2-3) on the Fazekas scale. The first systolic BP (SBP) and mean arterial pressure (MAP) from the ambulance and admission, and absolute BP change between these time points, were collected. The outcomes were in-hospital mortality, mortality at 180 days, modified Rankin Scale (mRS) scores at 3 months, and hematoma expansion.

RESULTS

Of 548 patients, 260 (47%) had moderate-to-severe WML. Compared to patients with none-to-mild WML, these patients had a stronger association between higher prehospital MAP and in-hospital mortality (p interaction 0.017). WML did not modify associations between prehospital BP and other outcomes. WML modified associations between MAP change and in-hospital mortality (p interaction 0.049), MAP change and mRS score 3-6 at 3 months (p interaction 0.032), and SBP change and mRS score 3-6 at 3 months (p interaction 0.022). These outcomes were poorer with greater BP decrease in patients with moderate-to-severe compared to none-to-mild WML.

DISCUSSION AND CONCLUSION

In acute ICH, WML modified the influence of prehospital BP and BP change on clinical outcomes, with a trend toward worse outcomes associated with higher prehospital BP and greater spontaneous BP decrease.

MeSH

White Matter, Mortality, Cerebral Hemorrhage, Hemorrhage, Blood, Stroke, Blood Pressure, Hospital Mortality, Wounds And Injuries