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Hatcher S, Chen C, Govindarajan P. Prehospital Systolic Hypertension and Outcomes in Patients with Spontaneous Intracerebral Hemorrhage. Cureus. 2017;9(1):e998doi: 10.7759/cureus.998.
Hatcher, S., Chen, C., & Govindarajan, P. (2017). Prehospital Systolic Hypertension and Outcomes in Patients with Spontaneous Intracerebral Hemorrhage. Cureus, 9(1), e998. https://doi.org/10.7759/cureus.998
Hatcher, Stacy, et al. "Prehospital Systolic Hypertension and Outcomes in Patients with Spontaneous Intracerebral Hemorrhage." Cureus vol. 9,1 (2017): e998. doi: https://doi.org/10.7759/cureus.998
Hatcher S, Chen C, Govindarajan P. Prehospital Systolic Hypertension and Outcomes in Patients with Spontaneous Intracerebral Hemorrhage. Cureus. 2017 Jan 26;9(1):e998. doi: 10.7759/cureus.998. PMID: 28280651; PMCID: PMC5325744.
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Cureus. 2017 Jan 26;9(1):e998. doi: 10.7759/cureus.998.

Prehospital Systolic Hypertension and Outcomes in Patients with Spontaneous Intracerebral Hemorrhage.

Cureus

Stacy Hatcher, Connie Chen, Prasanthi Govindarajan

Affiliations

  1. Department of Surgery, University of California San Francisco.
  2. Internal Medicine, Stanford Healthcare.
  3. Emergency Medicine, Stanford Healthcare.

PMID: 28280651 PMCID: PMC5325744 DOI: 10.7759/cureus.998

Abstract

BACKGROUND: It is well known that hematoma volume and expansion is associated with poor outcomes in patients with spontaneous intracerebral hemorrhage (sICH). The factors associated with hematoma volume and possible expansion include the use of anticoagulant medications, autoimmune or bacterial diseases that reduce platelet production, and genetic defects of Von Willebrand factor causing inhibition or reduction of platelet aggregation. However, little is known about the role of elevated systolic blood pressure (SBP) on hematoma volume and its ultimate role on sICH when identified in the prehospital setting. Our objectives were to determine the prevalence of elevated SBP among diagnosed sICH patients transported by emergency medical services (EMS), and to explore possible associations between prehospital elevated SBP and hematoma volume.

METHODS: This is a hypothesis-generating study for which we used a retrospective observational design. The subjects included 243 adult patients who were seen and treated for sICH in an emergency department serving a county hospital in a large metropolitan city. Elevated SBP in the setting of sICH was defined as ≥140 mm Hg. A univariate analysis was performed to investigate associations between patient demographics, elevated SBP, and sICH characteristics with the pre-determined outcome of hematoma volume. We then performed a multivariable logistic regression model to determine if elevated prehospital SBP remained associated with hematoma volume.

RESULTS: The number of subjects with a hospital-based diagnosis of sICH was 243. Of those, 193 (79%) were transported by an ambulance. Among those transported by ambulance, 180 (93%) had a documented prehospital SBP; out of those patients with a documented SBP, 173 (96%) showed an elevated SBP of ≥140 mm Hg, and 82 (46%) had a hematoma volume of ≥30 mL. Our univariate analysis showed that sICH patients with an elevated prehospital SBP of ≥140 mm Hg were associated with hematoma volume. The multivariable regression model showed that elevated prehospital SBP (≥140 mm Hg) was associated with larger hematoma volumes (odds ratio (OR) 3.86 95% confidence interval (CI) 1.02-4.60).

CONCLUSIONS: Prehospital elevated SBP is associated with larger hematoma volume in patients with sICH. Future studies should confirm these findings in a larger cohort of patients.

Keywords: ct; emergency medical services; hypertension; intracerebral hemorrhage; prehospital care; prehospital life support; stroke

Conflict of interest statement

The authors have declared that no competing interests exist.

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