Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 16:14:1114602.
doi: 10.3389/fneur.2023.1114602. eCollection 2023.

The association between blood pressure variability and perihematomal edema after spontaneous intracerebral hemorrhage

Lotte Sondag  1 , Axel Wolsink  1 , Wilmar M T Jolink  2 , Sabine Voigt  3   4 , Marianne A A van Walderveen  4 , Marieke J H Wermer  3 , Catharina J M Klijn  1 , Floris H B M Schreuder  1
Affiliations

The association between blood pressure variability and perihematomal edema after spontaneous intracerebral hemorrhage

Lotte Sondag et al. Front Neurol. .

Abstract

Background: Perihematomal edema (PHE) after spontaneous intracerebral hemorrhage (sICH) is associated with clinical deterioration, but the etiology of PHE development is only partly understood.

Aims: We aimed to investigate the association between systemic blood pressure (BP) variability (BPV) and formation of PHE.

Methods: From a multicenter prospective observational study, we selected patients with sICH who underwent 3T brain MRI within 21 days after sICH, and had at least 5 BP measurements available in the first week after sICH. Primary outcome was the association between coefficient of variation (CV) of systolic BP (SBP) and edema extension distance (EED) using multivariable linear regression, adjusting for age, sex, ICH volume and timing of the MRI. In addition, we investigated the associations of mean SBP, mean arterial pressure (MAP), their CVs with EED and absolute and relative PHE volume.

Results: We included 92 patients (mean age 64 years; 74% men; median ICH volume 16.8 mL (IQR 6.6-36.0), median PHE volume 22.5 mL (IQR 10.2-41.4). Median time between symptom onset and MRI was 6 days (IQR 4-11), median number of BP measurements was 25 (IQR 18-30). Log-transformed CV of SBP was not associated with EED (B = 0.050, 95%-CI -0.186 to 0.286, p = 0.673). Furthermore, we found no association between mean SBP, mean and CV of MAP and EED, nor between mean SBP, mean MAP or their CVs and absolute or relative PHE.

Discussion: Our results do not support a contributing role for BPV on PHE, suggesting mechanisms other than hydrostatic pressure such as inflammatory processes, may play a more important role.

Keywords: blood pressure; blood pressure variability; brain edema; intracerebral hemorrhage; perihematomal edema.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Association between (log-transformed) CV of SBP in the first week and the presence of PHE as measured by EED on 3T MRI (univariable regression analysis). 3T MRI, 3 tesla magnetic resonance imaging; CV, coefficient of variation; EED, edema extension distance; PHE, perihematomal edema; SBP, systolic blood pressure.
See this image and copyright information in PMC

References

    1. van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. (2010) 9:167–76. 10.1016/S1474-4422(09)70340-0 - DOI - PubMed
    1. Poon MT, Fonville AF, Al-Shahi Salman R. Long-term prognosis after intracerebral haemorrhage: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. (2014) 85:660–7. 10.1136/jnnp-2013-306476 - DOI - PubMed
    1. Wilkinson DA, Pandey AS, Thompson BG, Keep RF, Hua Y, Xi G. Injury mechanisms in acute intracerebral hemorrhage. Neuropharmacology. (2018) 134(Pt B):240–8. 10.1016/j.neuropharm.2017.09.033 - DOI - PMC - PubMed
    1. Urday S, Kimberly WT, Beslow LA, Vortmeyer AO, Selim MH, Rosand J, et al. . Targeting secondary injury in intracerebral haemorrhage–perihaematomal oedema. Nat Rev Neurol. (2015) 11:111–22. 10.1038/nrneurol.2014.264 - DOI - PubMed
    1. Chen Y, Chen S, Chang J, Wei J, Feng M, Wang R. Perihematomal edema after intracerebral hemorrhage: an update on pathogenesis, risk factors, and therapeutic advances. Front. Immunol. (2021) 12:740632. 10.3389/fimmu.2021.740632 - DOI - PMC - PubMed

LinkOut - more resources