Time-Dependent Association Between Prehospital Blood Pressure and Outcomes in Acute Spontaneous Intracerebral Hemorrhage.

backgroundElevated blood pressure (BP) after spontaneous intracerebral hemorrhage (ICH) is associated with poor outcomes, but the prognostic value of prehospital BP, particularly in relation to onset-to-arrival time, remains unclear. We investigated time-dependent associations of prehospital BP, arrival BP, and their early difference with in-hospital outcomes.

methodsWe conducted a retrospective cohort study using a prospectively maintained stroke registry at a tertiary medical center in Taipei, Taiwan (2016-2022). Adults (≥ 18 years) with spontaneous ICH transported by emergency medical services within 24 h of symptom onset and with available prehospital BP were included. First prehospital and hospital-arrival BP were analyzed. Outcomes were in-hospital mortality and stroke in evolution (SIE) within 72 h of hospital admission. Patients were stratified by onset-to-arrival time (< 3 vs. ≥ 3 h). Multivariable logistic regression and restricted cubic splines were applied.

resultsSix hundred ninety patients were included (mean age 64.7 years, 63.1% male; 336 < 3 h, 354 ≥ 3 h). In patients arriving ≥ 3 h, higher prehospital systolic BP, mean arterial pressure, and pulse pressure were independently associated with increased odds of in-hospital mortality, and higher arrival pulse pressure was also associated with mortality. Associations with SIE and early BP differences were weaker and were attenuated in fully adjusted models. Restricted cubic spline showed no nonlinear associations. No significant associations between BP measures and outcomes were observed in patients arriving < 3 h.

conclusionsHigher prehospital BP was associated with increased in-hospital mortality among patients presenting ≥ 3 h after onset, whereas such associations are not evident within 3 h.