Abstract W P325: Hematoma Volumes Are Independent of Elevated Prehospital Blood Pressure in Patients with Intracerebral Hemorrhage

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INTRODUCTION: In a recent prehospital interventional trial, it was observed that high prehospital BP in intracerebral hemorrhage (ICH) patients is associated with larger ICH volumes. We tested the hypotheses that higher prehospital BP is associated with larger baseline ICH volumes outside a clinical trial setting. METHODS: We conducted a retrospective analysis of a prospectively-maintained centralized database of electronic patient health care reports (ePCR), including serial BP measurements, of all patients transported by Emergency Medical Services (EMS) to the Emergency Department (ED) of a single hospital with acute stroke symptoms during an 18-month period. All patients with an EMS dispatch code for suspected stroke were included. Hospital charts and neuroimaging were reviewed. Hematoma and intraventricular hemorrhage (IVH) volumes were measured planimetrically. RESULTS: A total of 877 patients were transported by EMS for suspected stroke. ICH was diagnosed in 50 (5.7%) patients. Median (IQR) time from symptom onset to first BP measurement was 82 (362) minutes. Mean prehospital SBP was 173 ± 32 mmHg. Median baseline hematoma volume was 31.8 (53.2) ml and median total ICH volume was 33.4 (58.1) ml. Mean prehospital BP was unrelated to hematoma volume (R=0.12, p=0.42) and total ICH volume (R=0.14, p=0.34). Mean prehospital SBP in patients with hematoma volumes <33 ml (169 ± 32 mmHg) was similar to those ≥33 ml (177 ± 32 mmHg, p=0.45). Similar results were found with 15 ml (p=0.82), 45 ml (p=0.52), and 60 ml (p=0.50) hematoma volume cutoffs. Mean prehospital SBP in patients with total ICH volume <33 ml was similar (168 ± 33 mmHg) to those ≥33 ml (177 ± 31 mmHg, p=0.39). IVH was present in 16 (32%) patients. The mean prehospital BP did not differ in patients with IVH (180 ± 27 mmHg) when compared to those without IVH (169 ± 34 mmHg, p=0.10). CONCLUSION: Prehospital BP is consistently high across different ICH volumes. Hematoma and total ICH volumes are independent of prehospital BP. These findings do not preclude a prehospital BP treatment effect.