Abstract WP458: Blood Pressure at Hospital Arrival Does Not Reliably Distinguish Hypertensive Intracerebral Hemorrhage

Abstract

Introduction: Hypertension is a known risk factor for intracerebral hemorrhage (ICH), but it is unclear whether blood pressure (BP) elevation at hospital arrival can reliably distinguish ICH caused by hypertensive angiopathy from other potential etiologies. Methods: We performed a retrospective single-center cohort study using data from consecutive patients admitted with ICH from February-June 2018. Presumed ICH etiology, location, and other clinical predictors were prospectively adjudicated by two attending neurologists. We compared patients’ first recorded systolic BP (SBP) and mean arterial pressure (MAP) at hospital arrival stratified by hypertensive vs. non-hypertensive primary ICH etiology, with further adjustment for demographics and initial arrival location (direct arrival vs. transfer) using linear regression models. In a sensitivity analysis, we used ICH location (deep, lobar, or infratentorial) rather than etiology in our models to account for potential subjectivity in adjudication. Results: There were 110 ICH patients in our cohort (mean age 69.1 [SD 17.7], 55% male, median ICH score 1.5 [IQR 1-2]). The most frequent ICH etiologies were hypertension (58%), cerebral amyloid angiopathy (19%), vascular lesions (6%), and malignancy (5%); 43% of hemorrhages occurred in deep subcortical locations, 37% were lobar, and 14% were infratentorial. Mean SBP and MAP for patients with hypertensive ICH was 158.8 (SD 29.7) and 109.0 (SD 18.3), respectively, compared to 157.1 (SD 33.4) and 108.2 (SD 21.2) in patients with ICH caused by other etiologies (p=0.78; p=0.82). Fully-adjusted regression models showed that, relative to hypertensive ICH, those caused by non-hypertensive etiologies had similar arrival BP (mean SBP and MAP difference [95% CI], -0.2 [-12.3-11.8] and -0.8 [-8.4-6.8], respectively). In a sensitivity analysis, we found that lobar and infratentorial ICH had similar arrival BP relative to deep ICH (mean SBP and MAP difference [95% CI] 2.1 [-11.1-15.3] and 0.2 [-8.3-8.6] for lobar ICH; 6.5 [-12.0-25.0] and 3.8 [-8.0-15.6] for infratentorial ICH). Conclusion: BP at hospital arrival should not be used as a primary determinant of likely ICH etiology, as hypertension may be implicated in various subtypes of ICH.