Abstract WP245: Hyperacute Blood Pressure Variability is Associated with Early Neurological Deterioration
Background: Increased blood pressure variability (BPV) has been associated with worse outcomes in acute stroke. The effect of hyperacute (<4 hours) BPV on early neurologic deterioration (END) has not been described.
Objective: To investigate whether BPV in the first hours after stroke onset is associated with END from prehospital evaluation to presentation at the emergency department
Methods: All patients enrolled in the NIH Field Administration of Stroke Therapy-Magnesium (FAST-MAG) phase 3 trial were included. FAST-MAG was a multicenter, randomized, double-blind, placebo-controlled study looking at whether initiation of magnesium sulfate (20 grams/24 hours) in the prehospital setting of acute stroke would reduce disability. Study agent was initiated prior to hospital arrival < 2 hours from symptom onset. BPV was defined as the standard deviation of systolic blood pressure of all readings obtained by 4 hours after initiation of study agent. END was diagnosed as Glasgow Coma Scale (GCS) decrease by ≥ 2 points between the prehospital evaluation and post-emergency department arrival assessment by a study nurse.
Results: There were 1,700 cases evaluated by paramedics 24 minutes (15-45 IQR), and by study nurses 150 minutes (120-180) after symptom onset with a median of 6 (IQR 5-6) BP readings. The mean (±SD) age was 69±13 years, 42.6% were women, and the median prehospital GCS was 15 (IQR 14-15). The final diagnosis was cerebral ischemia in 73.3% of patients, intracranial hemorrhage in 22.8%, and a stroke-mimicking condition in 3.9%. END was seen in 202 (12%) of subjects, with higher rates noted in those with intracerebral hemorrhage (ICH) compared to cerebral ischemia (31% vs 6%). Overall, there was greater BPV in patients with END (23mmHg vs 15mmHg, p<0.001). Blood pressure variability was greater in cases of cerebral ischemia with END (N=1,245, 18mmHg vs 15mmHg, p=0.004) and in ICH cases with END (N=387, 23mmHg vs 15mmHg, p<0.001).
Conclusion: Greater blood pressure variability is associated with early neurologic deterioration in patients with cerebral ischemia and ICH evaluated <2 hours from symptom onset.
Author Disclosures: J. Kim: None. J.L. Saver: Other; Modest; Other; Modest; Dr. Saver is an employee of the University of California. The University of California, Regents receive funding for Dr Saver’s services as a scientific, consultant regarding trial design. The University of California, Regents receive funding for Dr Saver’s services as a scientific consultant regarding trial design and conduct to, Covidien, Stryker, BrainsGate, Pfizer & St. Jude Medical, Dr. Saver has served as an unpaid site investigator in multicenter trials run by Lundbeck for which UC Regents received, payments on basis of clinical trial contracts for the number of subjects enrolled, Dr. Saver serves as an unpaid consultant to Genentech advising on design & conduct of PRISMS trial;, neither Univ. of California nor Dr. Saver received any payments for this voluntary unpaid service. The University of California has patent rights in retrieval devices for stroke. D.S. Liebeskind: Research Grant; Significant; NIH-NINDS. Consultant/Advisory Board; Significant; Medtronic, Stryker. S. Starkman: None. S. Hamilton: None. P. Chung: None. N. Sanossian: None.
- © 2017 by American Heart Association, Inc.