Admission Systolic Blood Pressure Predicts the Number of Blood Pressure Medications at Discharge in Patients With Primary Intracerebral Hemorrhage

作者：Khawaja Ayaz M^*; Shiue Harn; Boehme Amelia K; Albright Karen C; Venkatraman Anand; Kumar Gyanendra; Lyerly Michael J; Hays Shapshak Angela; Mirza Maira; Gropen Toby I; Harrigan Mark R

来源：Neurologist, 2018, 23(2): 60-64.

DOI：10.1097/NRL.0000000000000173

• hypertension
• blood pressure in acute stroke
• blood pressure management
• intracerebral hemorrhage
• intracranial hemorrhage

Background:Control of systolic blood pressure (SBP) after primary intracerebral hemorrhage improves outcomes. Factors determining the number of blood pressure medications (BPM) required for goal SBP<160mmHg at discharge are unknown. We hypothesized that higher admission-SBPs require a greater number of BPM for goal discharge-SBP<160mmHg, and investigated factors influencing this goal.Materials and Methods:We conducted a retrospective review of 288 patients who presented with primary intracerebral hemorrhage. Admission-SBP was obtained. Primary outcome was the number of BPM at discharge. Comparison was made between patients presenting with and without a history of hypertension, and patients discharged on <3 and 3 BPM.Results:Patients with hypertension history had a higher median admission-SBP compared with those without (180 vs. 157mmHg, P=0.0001). In total, 133 of 288 (46.2%) patients were discharged on <3 BPM; 155/288 (53.8%) were discharged on 3 BPM. Hypertension history (P<0.0001) and admission-SBP (P<0.0001) predicted the number of BPM at discharge. In patients without hypertension history, every 10mmHg increase in SBP resulted in an absolute increase of 0.5 BPM at discharge (P=0.0011), whereas in those with hypertension, the absolute increase was 1.3 BPM (P=0.0012). In comparison with patients discharged on <3 BPM, patients discharged on 3 BPM were more likely to have a higher median admission-SBP, be younger in age, belong to the African-American race, have a history of diabetes, have higher median admission-National Institutes of Health Stroke Scale and modified Rankin Scale of 4 to 5 at discharge.Conclusions:An understanding of the factors influencing BPM at discharge may help clinicians better optimize blood pressure control both before and after discharge.

• 出版日期2018-3