Clinical relevance of severe initial hypertension in acute intracerebral haemorrhage

Abstract

OBJECTIVE: To characterise severe initial hypertension (SIH) in the acute intracerebral haemorrhage (ICH) and the related clinical outcomes. METHODOLOGY: We prospectively identified patients admitted to a regional hospital with acute ICH between January 2003 and September 2003. SIH was defined by systolic BP >180 mmHg, diastolic BP >105 mmHg and/or mean BP >130 mmHg for 2 or more readings at 10 or more minutes apart. Clinical data was recorded and analyzed. The modified Rankin score was used to assess disability. RESULTS: A total of 102 patients were identified. SIH was found in 72 patients (70.6%). Comparing those with SIH and those without SIH, they differed statistically in Glasgow Coma Scale (p=0.03), National Institutes of Health Stroke Scale (p<0.001), volume of ICH (p=0.006), past history of hypertension (p=0.03) and time from onset to hospital arrival (p=0.013). Patients with SIH had a statistically significant increase in 30-day mortality (p=0.028) and 3-month mortality (p=0.016) as well as increase in 30-day disability (p=0.003) and 3-month disability (p=0.006). However, the correlation between SIH and mortality or disability was lost when controlling for the above factors. Furthermore, about half of the patients with SIH had their BP subsided within the first day, and this was associated with a significantly lower 30-day disability (p=0.033) and 3-month disability (p=0.045). CONCLUSION: SIH in acute ICH is related to a poor neurological state, an increased volume of ICH, a past history of hypertension and a shorter delay from onset. SIH is a prognostic indicator for mortality and disability but is not an independent factor. As those with early settle of BP have a lower disability, aggressive BP control in the acute phase of ICH may lessen the morbidity.