Larsen Kristin Tveitan, Holt Jahr Silje, Nordahl Selseth Maiken, Lied-Herland Trine, Hillestad Vigdis, Ihle-Hansen Hege, Sandset Else Charlotte, Rønning Ole Morten, Kristoffersen Espen Saxhaug
Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
Eur Stroke J. 2025 Jun 11:23969873251343495. doi: 10.1177/23969873251343495.
There are concerns about the safety of intensive blood pressure (BP) lowering in intracerebral hemorrhage (ICH) patients with white matter lesions (WML). We explored the impact of WML on associations between i) prehospital BP, and ii) BP change, and outcomes in acute, spontaneous ICH.
This retrospective study included consecutive patients with acute spontaneous ICH, admitted 2011-2020. WML on non-contrast computed tomography were categorized as none-to-mild (0-1) or moderate-to-severe (2-3) on the Fazekas scale. The first systolic BP (SBP) and mean arterial pressure (MAP) from the ambulance and admission, and absolute BP change between these time points, were collected. The outcomes were in-hospital mortality, mortality at 180 days, modified Rankin Scale (mRS) scores at 3 months, and hematoma expansion.
Of 548 patients, 260 (47%) had moderate-to-severe WML. Compared to patients with none-to-mild WML, these patients had a stronger association between higher prehospital MAP and in-hospital mortality ( interaction 0.017). WML did not modify associations between prehospital BP and other outcomes. WML modified associations between MAP change and in-hospital mortality ( interaction 0.049), MAP change and mRS score 3-6 at 3 months ( interaction 0.032), and SBP change and mRS score 3-6 at 3 months ( interaction 0.022). These outcomes were poorer with greater BP decrease in patients with moderate-to-severe compared to none-to-mild WML.
In acute ICH, WML modified the influence of prehospital BP and BP change on clinical outcomes, with a trend toward worse outcomes associated with higher prehospital BP and greater spontaneous BP decrease.
脑出血（ICH）合并白质病变（WML）患者强化降压的安全性受到关注。我们探讨了WML对以下关联的影响：i）院前血压与ii）血压变化以及急性自发性ICH患者预后之间的关联。
这项回顾性研究纳入了2011年至2020年收治的连续急性自发性ICH患者。非增强计算机断层扫描上的WML根据Fazekas量表分为无至轻度（0-1）或中度至重度（2-3）。收集救护车转运时和入院时的首次收缩压（SBP）和平均动脉压（MAP），以及这两个时间点之间的绝对血压变化。结局指标包括住院死亡率、180天死亡率、3个月时的改良Rankin量表（mRS）评分以及血肿扩大情况。
548例患者中，260例（47%）有中度至重度WML。与无至轻度WML的患者相比，这些患者院前MAP升高与住院死亡率之间的关联更强（交互作用0.017）。WML未改变院前血压与其他结局之间的关联。WML改变了MAP变化与住院死亡率之间的关联（交互作用0.049）、MAP变化与3个月时mRS评分3-6之间的关联（交互作用0.032）以及SBP变化与3个月时mRS评分3-6之间的关联（交互作用0.022）。与无至轻度WML的患者相比，中度至重度WML患者血压下降幅度越大，这些结局越差。
在急性ICH中，WML改变了院前血压和血压变化对临床结局的影响，院前血压升高和自发性血压下降幅度越大，结局越差的趋势越明显。
