Rate of 24-hour blood pressure decline and mortality after spontaneous XXXX : a retrospective analysis with a random effects regression model.

@entity1 @entity772 @entity1410 @entity551 @entity1779
OBJECTIVE: To study the effect of decline in blood pressure on mortality in @entity1 with spontaneous @entity1779 ( @entity1779 ). DESIGN: Retrospective chart review. SETTING: University-affiliated teaching hospital. @entity1 : Consecutive @entity1 admitted with spontaneous @entity1779 over a 3-year period. MEASURES: Blood pressure recordings were obtained from the first 24 hrs. @entity1 (n = 105) with more than five blood pressure recordings and on average greater than one measurement per 2 hrs were included (mean measurements per @entity1 = 20.3). @entity551 ( @entity551 ) recordings over the first 24 hrs after presentation were regressed on time for each @entity1 . Each @entity1 's @entity551 was calculated as a slope (change mm Hg/hr). We performed logistic regression analyses to determine the effect of @entity551 slope on mortality and functional outcome, adjusting for other predictive factors including Glasgow @entity772 Scale (GCS) score and @entity1410 volume. The effect of @entity551 slope on mortality was also evaluated in subsets of @entity1 based on age, gender, initial GCS score, initial @entity551 , treatment status, @entity1410 volume, and presence of ventricular blood. MAIN RESULTS: Mean slope of change in @entity551 was -2.0 mm Hg/hr (+/- 1.9, range -8.5 to +0.6). The slope of @entity551 (faster rate of decline) within the first 24 hrs was significantly associated with higher mortality (p =.04), independent of initial GCS score and @entity1410 volume. In subgroup analyses, @entity551 slope was significantly associated with mortality in @entity1 (p = .08), @entity1 with @entity1410 volume <50 mm3 (p =.08), initial @entity551 < or = 146 mm Hg (p = .006), and those with initial GCS score > or = 10 (p= .07). @entity551 slope did not predict functional outcome among survivors. CONCLUSIONS: A rapid decline in @entity551 within 24 hrs after presentation is independently associated with increased mortality in @entity1 with @entity1779 . A large, prospective, randomized trial is required to confirm these findings.
