Introduction: The relationship between blood pressure variability (BPV) and clinical outcomes in patients with subarachnoid hemorrhage (SAH) has not been studied. However, in patients suffering from stroke, BPV during the acute period (the first 24 hours following hemorrhage) can predict functional outcomes in patients with stroke. This study sought to identify whether BPV influences outcomes at discharge in aneurysmal SAH (aSAH) patients.
Methods: A retrospective chart review from 2007 to 2016 was conducted for all patients with aSAH surviving to discharge. Patient demographics, delayed cerebral ischemia (DCI), delayed ischemic neurological decline (DIND), angiographic vasospasm, and SAH characteristics were collected. The primary outcome was discharge modified Rankin scale (mRS). Blood pressure (BP) data were recorded in the first 24 hours post-admission and included; mean systolic BP (SBP) and standard deviation (SD), coefficient of variation (CV), maximum SBP, minimum SBP, and median arterial pressure (MAP).
Results: A total of 156 patients met eligibility criteria. The mean age was 54 years, and 66% of patients were female. Only 43% of patients had history of hypertension. At discharge, 126 patients had mRS 0-2 (80.8%). On univariate analysis, Hunt and Hess (p<0.01), Glasgow coma scale (p<0.01), angiographic vasospasm (p=0.01), SD SBP (p<0.01), DCI (p<0.01), CV SBP (p=0.01) were predictors of functional outcome. On multivariate analysis, Hunt and Hess (OR 2.62; 95% CI 1.30–5.27), SD SBP (0.93; 0.87–0.99) and CV SBP (0.89; 0.80–0.99) remained as independent predictors of functional outcome. BPV did not predict DIND or DCI. A repeated measure analysis of blood pressure change over time did not show a statistical difference between functional outcome cohorts (SBP p=0.63; MAP p=0.88).
Conclusions: Patients with lower systolic BPV in the acute period after aSAH onset had a worse functional outcome at discharge.
Patient Care: Blood pressure control is one of the main goals in the clinical management of aneurysmal subarachnoid hemorrhage. Knowing how blood pressure variations in the acute period affect functional outcomes at discharge will help in determining the goals of blood pressure levels.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of blood pressure changes in the acute period in predicting functional outcomes at discharge. 2) Discuss, in small groups, How blood pressure variability affects functional outcomes at discharge.