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

Lotte Sondag; Axel Wolsink; Wilmar M T Jolink; Sabine Voigt; Marianne A A van Walderveen; Marieke J H Wermer; Catharina J M Klijn; Floris H B M Schreuder

doi:10.3389/fneur.2023.1114602

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

Front Neurol. 2023 Mar 16:14:1114602. doi: 10.3389/fneur.2023.1114602. eCollection 2023.

Authors

Lotte Sondag¹, Axel Wolsink¹, Wilmar M T Jolink², Sabine Voigt^{3

4}, Marianne A A van Walderveen⁴, Marieke J H Wermer³, Catharina J M Klijn¹, Floris H B M Schreuder¹

Affiliations

¹ Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands.
² Department of Neurology, Isala Hospital, Zwolle, Netherlands.
³ Department of Neurology, Leiden University Medical Center, Leiden, Netherlands.
⁴ Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.

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.

Grants and funding

MW was supported by a personal ZonMw VIDI grant (91717337) and the Dutch Heart Foundation (2016T86). FS was supported by the Dutch Heart Foundation (2019T060). This work (LS) was supported by the CONTRAST consortium, which acknowledges the support from the Netherlands Cardiovascular Research Initiative, an initiative of the Dutch Heart Foundation (CVON2015-01: CONTRAST), and from the Brain Foundation Netherlands (HA2015.01.06). The collaboration project is additionally financed by the Ministry of Economic Affairs by means of the PPP Allowance made available by the Top Sector Life Sciences and Health to stimulate public-private partnerships (LSHM17016). The consortium received unrestricted funding by Stryker, Medtronic, and Cerenovus for research. Radboud UMC and Erasmus MC received additional unrestricted funding on behalf of CONTRAST, and for the execution of the Dutch ICH Surgery Trial pilot study. For the Dutch ICH Surgery Trial, Radboudumc, and Erasmus MC received funding from Penumbra Inc., ZonMw, and Zorginstituut. The funding sources were not involved in study design, monitoring, data collection, statistical analyses, interpretation of results, or manuscript writing.