Time course of beat-to-beat blood pressure variability and outcome in patients with spontaneous intracerebral haemorrhage

Objectives: Increased blood pressure variability (BPV) over 24 h or longer was associated with poor clinical outcomes in patients with intracerebral haemorrhage (ICH). However, the characteristics of beat-to-beat BPV, a rapid assessment of BPV and its association with outcome in ICH patients remain unknown. Methods: We consecutively and prospectively recruited patients with ICH between June 2014 and December 2020. Five-minute noninvasive beat-to-beat recordings were measured serially at three time points, 1–2, 4–6 and 10–12 days after ICH onset. BPV was calculated using standard deviation (SD) and variation independent of mean (VIM). Favourable outcome was defined as modified Rankin Scale score of less than 2 at 90 days. Results: The analysis included 66 participants (54.12 ± 10.79 years; 71.2% men) and 66 age and sex-matched healthy controls. Compared with that in healthy adults, beat-to-beat BPV was significantly increased 1–2 days after ICH and was completely recovered 10–12 days later. BPV recorded 1–2 days after ICH onset was higher among patients with unfavourable outcomes than among those with favourable outcomes (all P < 0.05) and higher BPV on days 1–2 was independently associated with a 3-month unfavourable outcome after adjustment for major covariates. Conclusion: Beat-to-beat BPV was significantly increased among patients with ICH and could be completely recovered 10–12 days later. In addition, beat-to-beat BPV 1–2 days after ICH was independently associated with prognosis and could be regarded as a potential prognostic predictor and effective therapeutic target in the future.