Increased Pulse Pressure Variability Within the First 24 Hours Leads to Poor Disposition in Subarachnoid Hemorrhage Patients.Citation: American Journal of Hypertension. 34(6):645-650, 2021 06 22.PMID: 33537749Institution: MedStar Medical Group | MedStar Washington Hospital CenterDepartment: Neurosurgery | Radiology | Surgery/Surgical Critical CareForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Blood Pressure | *Subarachnoid Hemorrhage | Blood Pressure/ph [Physiology] | Humans | Prospective Studies | Retrospective Studies | Subarachnoid Hemorrhage/th [Therapy] | Time Factors | Treatment OutcomeYear: 2021ISSN:
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BACKGROUND: Aneurysmal subarachnoid hemorrhage (SAH) continues to be associated with significant morbidity and mortality despite treatment advancements. Although high blood pressure (BP) remains a significant risk factor in aneurysmal SAH and re-rupture, the role of BP parameters and fluctuation in prognostication remains unclear.
CONCLUSION: Increased BP and PP variability within the first 24 hours of admission portends a poor discharge disposition for aneurysmal SAH patients. Copyright (c) American Journal of Hypertension, Ltd 2021. All rights reserved. For Permissions, please email: journal[email protected].
METHODS: We retrospectively analyzed a prospectively collected cohort of SAH patients. Hourly BP parameters, including systolic BP, diastolic BP, pulse pressure (PP), and their corresponding variability (delineated by standard deviation) were collected to investigate associations with the primary endpoint of discharge disposition.
OBJECTIVE: We sought to define how BP parameters and variability within 24 hours of hospitalization in acute-onset SAH affects patient discharge outcomes.
RESULTS: 174 SAH patients were included in the study. On bivariate analysis, Hunt Hess score, Fisher grade, intraventricular hemorrhage, external ventricular drain placement, and systolic BP and pulse pressure variability were significantly associated with a poor disposition. Poor disposition was significantly associated with age, Hunt Hess score, intraventricular hemorrhage, and PP variability on multivariate analysis. PP variability remained an independent predictor for poor disposition (OR 1.11, 95%CI 1.02-1.21, p = 0.02) when adjusting for potential confounders.