Predictors Of Severity Of Hypertensive Response In Acute Intracerebral Haemorrhage

Objectives: Early elevation in blood pressure (BP) known as acute hypertensive response is common in patients with spontaneous intracerebral hemorrhage (ICH), and a known predictor of a poor outcome. We aimed to identify the independent predictors. Methods: We pooled Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT1) (n = 404) and INTERACT2 (n = 2839) of acute ICH patients (<6 hrs of onset) with elevated systolic BP (SBP, 150–220 mmHg) who were randomized to intensive (target SBP < 140 mmHg) or guideline-recommended (target SBP < 180 mmHg) management. BP at randomisation was measured at least twice and at least two minutes apart using the non-paretic arm (or right arm in situations of coma or tetraparesis) with the patient supine. Multivariable linear regression was used to determine associations. Results: Among 3233 patients, the mean age was 63.4 (12.8) years, mean SBP 179.3 (17.1) mmHg and 36.8% were female. History of hypertension (estimate 2.295, SE 0.691), admission glycemia > 6.5 mmol/lt (3.132, 0.618), elevated heart rate (1.238, 0.222 per 10-bmp increase), and higher NIHSS (0.154, 0.047 per 1-point increase) were significantly associated with hypertensive response at baseline. The use of antithrombotics (−3.742, 0.954) and time from onset to randomization (−0.992, 0.255 per 1-hour increase) were inversely associated with hypertensive response. Conclusion: For patients with acute ICH, if they are with history of hypertension, elevated blood glucose and heart rate, severe neurological deficit, not on antithrombotics, and presented earlier, more frequent BP measurement is required and more intensive BP treatment may be needed.