Abstract WP422: The BPV Score to Predict Blood Pressure Variability After Acute Intracranial Hemorrhage: A Secondary Analysis of ATACH-2

Abstract

Introduction: Increased blood pressure variability (BPV) is associated with worse neurologic outcome in patients with acute intracerebral hemorrhage. However, it is difficult to identify which patients will have elevated BPV and would be best for clinical trials aimed at reducing BPV. Methods: This is a secondary analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2) trial. Our primary outcome is the top quintile of the systolic blood pressure standard deviation (SBP SD), which was calculated using all available blood pressures after the first 2 hours. With stepwise backwards selection and an interactive process, we created the BPV Score to predict the top quintile of SBP SD. Results: We included 997 patients. The BPV Score is calculated by adding one point each for: female sex, Caucasian race, baseline NIHSS>10, intubation, and external ventricular drain. After collapsing the scores of 4 and 5, the breakdown of scores was 0=19.1%, 1=34.2%, 2=29.3%, 3=10.5%, 4=6.9%. The AUC for the BPV Score is 0.722 (Figure 1) and probability of accurately predicting the top quintile of SBP SD is seen in Figure 2. Conclusion: The BPV Score is a promising tool for predicting higher levels of BPV in the days following acute intracerebral hemorrhage. A clinical trial to reduce BPV may chose to target patients with scores of 3 or 4 and confirm elevated BPV during a run-in period.