22. European Stroke Conference 592 © 2013 S. Karger AG, Basel Scientific Programme 21 Intracerebral/subarachnoid haemorrhage and venous diseases Impact of potential systolic blood pressure therapeutic target thresholds on hematoma growth in patients with acute intracerebral hemorrhage D. Rodrigiez-Luna1, M. Muchada2, M. Rubiera3, P. Coscojuela4, M. Ribo5, J. Pagola6, A. Flores7, B. Ibarra8, P. Meler9, E. Sanjuan10, M. Hernandez-Guillamon11, A. Tomasello12, J. Alvarez-Sabin13, J. Montaner14, C.A. Molina15 Vall d’Hebron University Hospital, Barcelona, SPAIN1, Vall d’Hebron University Hospital, Bar-celona, SPAIN2, Vall d’Hebron University Hospital, Barcelona, SPAIN3, Vall d’Hebron University Hospital, Barcelona, SPAIN4, Vall d’Hebron University Hospital, Barcelona, SPAIN5, Vall d’Hebron University Hospital, Barcelona, SPAIN6, Vall d’Hebron University Hospital, Barcelona, SPAIN7, Vall d’Hebron University Hospital, Barcelona, SPAIN8, Vall d’Hebron University Hospital, Barcelo-na, SPAIN9, Vall d’Hebron University Hospital, Barcelona, SPAIN10, Vall d’Hebron University Hospital, Barce-lona, SPAIN11, Vall d’Hebron University Hospital, Barcelona, SPAIN12, Vall d’Hebron University Hospital, Barcelona, SPAIN13, Vall d’Hebron University Hospital, Barcelona, SPAIN14, Vall d’He-bron University Hospital, Barcelona, SPAIN15 Background: Different current guidelines recommend maintaining systolic blood pressure (SBP) below 180 mmHg in acute intracerebral hemorrhage (ICH). However, little is known about the re-lationships between different SBP therapeutic target thresholds and hematoma growth (HG). There-fore, we aimed to investigate the impact of potential SBP treatment thresholds on HG in patients with acute ICH. Methods: This study was a secondary analysis of data prospectively collected during a previously reported study of the impact of blood pressure (BP) on HG in 106 patients with acute (<6 hours) su-pratentorial ICH. Patients underwent baseline and 24-hour computed tomography scans, and nonin-vasive BP monitoring at 15 minutes interval over first 24 hours. SBP loads were defined as the per-centage of 24-hour SBP monitoring values exceeding 140, 150, 160, 170, 180, 190, and 200 mmHg. HG was defined as hematoma enlargement >33% or >6 mL at 24 hours. Results: Patients who experienced HG (34%) presented higher SBP loads in all thresholds, reaching statistical significance in 170, 180, and 190 thresholds (Figure). For these thresholds, ROC curves identified SBP 170-load >18.7%, SBP 180-load >12.3%, and SBP 190-load >2.1% as the cut-off points that predicted HG with the highest sensitivity and specificity. Similarly, higher (170 to 200) but not lower (140 to 160) thresholds were correlated with the amount of both relative and absolute hematoma enlargement at 24 hours (p<0.05), and not to either baseline or 24-hour ICH volumes. In multivariate analyses, both SBP 170-load (OR 1.034, 95% CI 1.001–1.070, p=0.048) and 180-load (OR 1.052, 95% CI 1.010–1.097, p=0.016) were independently related to HG. Conclusions: In patients with acute supratentorial ICH, those who experience HG present higher SBP load from 140 to 200 mmHg thresholds. More intensive SBP-lowering treatment than guide-lines recommendations is needed, at least below 170 mmHg, to minimize the deleterious effect of higher SBP on HG.
Karger_ESC London_2013
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