title: Blood pressure at hospital admission and outcome after primary intracerebral hemorrhage.
abstract: BACKGROUND
  The importance of the admission blood pressure (BP) for intracerebral hemorrhage (ICH) outcome is not completely clear. Our objective was to analyze the clinical impact of BP at hospital arrival in patients with primary ICH.
  
  
  METHODS
  We studied 316 patients (50% women, mean age: 64 years, 75% with hypertension history) with acute primary ICH. The first BP reading at admission was evaluated for its association with neuroimaging findings and outcome. A Cox proportional hazards model and Kaplan-Meier analyses were constructed to evaluate factors associated with in-hospital mortality.
  
  
  RESULTS
  Intraventricular irruption occurred in 52% of cases. A high frequency of third ventricle extension was observed in patients with BP readings in the upper quartiles of the distribution (systolic, diastolic, or mean arterial pressure). Blood pressure readings did not correlate with hematoma volumes. In-hospital case fatality rate was 46% (63% among those with ventricular irruption). Systolic BP (SBP) > 190 mm Hg was independently associated with in-hospital mortality in supratentorial (n = 285) ICH (hazard ratio: 1.19, 95% confidence interval: 1.02-1.38, for the highest vs. the lowest quartile) even after adjustment for known strong predictors (age, ICH volume, Glasgow coma scale and ventricular extension). Blood pressure was not significantly associated with ventricular extension or outcome in patients with infratentorial ICH.
  
  
  CONCLUSIONS
  A high BP on admission is associated with an increased risk of intraventricular extension and early mortality in patients with supratentorial ICH. However, a significant proportion of patients with high BP readings without ventricular irruption still have an increased risk of death.
authors.affiliation: Neurology and Psychiatry Department, Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran", Guadalajara, Mexico.
authors.forename: Erwin
authors.initials: E
authors.lastname: Chiquete
authors.forename: Ana
authors.initials: A
authors.lastname: Ochoa-Guzmán
authors.forename: Angel
authors.initials: A
authors.lastname: Vargas-Sánchez
authors.forename: Jorge
authors.initials: J
authors.lastname: Navarro-Bonnet
authors.forename: Miquel A
authors.initials: MA
authors.lastname: Andrade-Ramos
authors.forename: Patricia
authors.initials: P
authors.lastname: Gutiérrez-Plascencia
authors.forename: José L
authors.initials: JL
authors.lastname: Ruiz-Sandoval
keywords: blood pressure; diastolic; hematoma; hypertension; intracerebral hemorrhage; outcome; systolic