Acute Blood Pressure and Outcome After Intracerebral Hemorrhage: The VISTA-ICH Cohort

Background: Recent clinical trials suggest that it is safe to acutely lower systolic blood pressure (BP) to 140 mm Hg after ICH, but uncertainty remains regarding optimal management. We sought to better define the link between BP and outcome in ICH patients using data from the Virtual International Stroke Trials Archive (VISTA). Methods: We performed a retrospective analysis of patients of the VISTA-ICH trials. We measured the strength of association between systolic and diastolic BP various components at different timepoints with unfavorable 3 month-outcome, defined as death or moderate-to-severe disability at 3 months (mRS of 4-6), after adjustment for known confounders. We also dichotomized BP values obtained at 24 h at different thresholds to better define an optimal treatment target. The association of BP with hematoma expansion (HE) was also analyzed. Results: A total of 384 patients were included. Higher BP at 24 hours was associated with unfavorable outcome for systolic BP (OR 1.16, 95% C.I. 1.07–1.25), pulse pressure (OR 1.13, 95% C.I. 1.03–1.24), and diastolic BP (OR 1.11, 95% C.I. 1.01–1.23) per 10 mm Hg increment. The association between higher BP at 24 h and unfavorable outcome remained significant down to >140 mm Hg. Elevated systolic BP at 24 h was also associated with HE (OR 1.11, 95% C.I. 1.02–1.21 per 10 mm Hg increment). Conclusion: Elevated BP after ICH at 24 h is associated with poor outcome. Our results support the practice of targeting a systolic BP of 140 mm Hg.