Relationship between systolic blood pressures measured in emergency department and outcomes in patients with subarachnoid hemorrhage

Abstract

Aim: High blood pressure is observed frequently in patients with subarachnoid hemorrhage who present to the emergency department. Although extremely high blood pressure is known to predict poor outcomes in patients with spontaneous intracerebral hemorrhage, the relationship between high blood pressure and outcomes has been studied less frequently in patients with subarachnoid hemorrhage.Methods: A retrospective study was carried out to evaluate whether high blood pressure observed in the emergency department was predictive of poor outcomes in patients with subarachnoid hemorrhage. Three-hundred and twelve subarachnoid hemorrhage patients who were admitted to our institution were quadrichotomized based on their initial systolic blood pressure: <140 mmHg (n = 60), 140-184 mmHg (n = 144), 185-219 mmHg (n = 64), and ≥220 mmHg (n = 44). Demographics including subarachnoid hemorrhage severity (World Federation of Neurosurgical Societies grade) and outcome variables evaluated with the modified Rankin scale 30 days after admission were compared among the four blood pressure groups. Furthermore, an effort was made to delineate a threshold value of systolic blood pressure predictive of outcomes by receiver operating characteristic curve analysis. Results:The frequency of grade V subarachnoid hemorrhage in the ≥220 mmHg group (55%) was significantly higher than in the other three blood pressure groups. The frequency of patients scoring 5-6 on the modified Rankin scale in the ≥220 mmHg group (54%) was significantly higher than in the other three blood pressure groups. The cut-off systolic blood pressure value predicting poor outcomes (modified Rankin scale 5-6) determined by receiver operating characteristic curve analysis was 189 mmHg. Conclusions:The higher proportion of grade V patients may be responsible for the worse outcomes in the group with systolic blood pressure ≥220 mmHg. Initial systolic blood pressure ≥220 mmHg may be a crude indicator of poor outcomes in patients with subarachnoid hemorrhage.Key words: Emergency department, high blood pressure, outcomes, predictability, subarachnoid hemorrhage INTRODUCTION H IGH BLOOD PRESSURE (HBP) is observed frequently in patients with hemorrhagic stroke.1,2 It has been repeatedly reported that the higher the BP in the emergency department (ED), the worse the outcomes of patients with spontaneous intracerebral hemorrhage.3-6 By contrast, the relationship between BP measured in the ED and outcomes has been studied less frequently in patients with aneurysmal subarachnoid hemorrhage (SAH). 7,8 It may be beneficial for emergency physicians if earlier prognostication of SAH patients was possible using BP values measured in the ED. For that purpose, the relationship between: (i) systolic BPs (SBPs) in the ED and severity of SAH; and (ii) SBPs in the ED and outcomes, was investigated in this study. Furthermore, an effort was made to delineate a threshold value of SBP predictive of poor outcomes with receiver operating characteristic (ROC) curve analysis. METHODS PatientsT HIS WAS ...

Impact of blood pressure on the outcomes of inpatients with Subarachnoid hemorrhage

“…Finally, we did not assess mortality, which may have biased our study, although this has already been investigated by another group. [ 18 ] Despite these limitations, our results encourage the implementation of strict BP control among patients admitted to the hospital for rehabilitation after SAH.…”

“…Inamasu et al performed a retrospective study to evaluate whether hypertension, as observed in the emergency department, is predictive of poor outcomes in patients with SAH using the mRS at 30 days after admission [ 18 ] and concluded that an initial systolic BP ≥220 mm Hg may be a crude indicator of poor outcomes in these patients. Ohkuma et al investigated 273 Asian patients with SAH who were admitted to Japanese institutions within 24 hours of their initial bleeding and found that a systolic arterial pressure >160 mm Hg was a possible risk factor for rebleeding.…”

Racial differences in time to blood pressure control of aneurysmal subarachnoid hemorrhage patients: A single-institution study

“…Uncontrolled blood pressure is a factor that has been historically associated with aSAH incidence and outcomes [5,17,18,28]. A prior study in Japan suggested that high initial systolic blood pressure (�220 mmHg) is a risk factor for higher grade hemorrhage [29]. One study with 612 aSAH patients, all with BP controlled to 120-160 mmHg, found that increased BP variability correlated with a significantly increased risk of rebleed [30].…”

Aneurysmal subarachnoid hemorrhage occurring while driving and road traffic accidents

“…Patients who sustain aSAH frequently experience loss of consciousness (either transient or long-lasting). 3 A recent study found that approximately 40% of patients with aSAH had experienced loss of consciousness by the time they arrived at ED. 4 The frequency of RTA in aSAH-afflicted drivers (31%) seems to be compatible with that finding.…”