Letter re: Ischemic Lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage

We appreciated the article by Kidwell et al.1 that showed higher first-recorded blood pressure (BP) and greater delta mean arterial pressure are associated with the development of diffusion-weighted imaging (DWI) lesions in acute intracerebral hemorrhage (ICH). The most desirable BP target and optimal antihypertensive strategy in ICH are controversial.2 The relationship between BP and outcome is more complex than simply linear, and mechanisms other than BP reduction play a role. There is accruing evidence that not only absolute BP levels but their variation over time affect ICH prognosis.3 Besides increasing the risk of hematoma enlargement, BP fluctuations could favor remote ischemia by working synergistically with preexistent burden of cerebral small angiopathy, namely leukoaraiosis and microbleeds, and influence the stroke outcome. Both systolic and diastolic BP dysregulation deserve more comprehensive assessment through the proper measures of variability, such as standard and residual deviation, variation coefficient, average real variability, and variation independent of the mean.4 In addition, time to MRI differed among DWI+ and DWI– patient subgroups, which could represent a meaningful bias: it would be appropriate to include this variable among the controlling factors of the multivariable predictive model for DWI lesions development.
Source: Neurology - Category: Neurology Authors: Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research