1076. Effect of blood pressure variability during the acute period of aneurysmal subarachnoid hemorrhage in functional outcomes

Authors: Luis Ascanio, MD; Alejandro Enriquez-Marulanda, MD; Georgios Maragkos, MD; Mohamed Salem, MD; Justin Moore, MD, PhD; Abdulrahman Alturki; Krishnan Ravindran, BS; Christopher Ogilvy, MD; Ajith Thomas, MD (Boston, MA)

Introduction: The relationship between systolic blood pressure (SBP) variability and clinical outcomes in the acute period of aneurysmal subarachnoid hemorrhage (aSAH) has not been studied. This study sought to identify whether SBP variability influences outcomes at last follow-up in aSAH patients. Methods: A retrospective chart review from 2007 to 2016 in a single center was conducted for all patients with aSAH diagnosed on admission CT scan and surviving to discharge. Excluded patients had more than 4 blood pressure values missing. Patient demographics, clinical, and radiological aSAH features were recorded. Blood pressure readings were recorded at admission and every 4 hours up to 24 hours. Variability of SBP was assessed by mean, standard deviation (SD), maximum SBP, minimum SBP, peak SBP, through SBP, coefficient of variation (CV), and successive variation (SV). The primary outcome was a composite of modified Rankin scale (mRS) as good (mRS 0-2) or poor (mRS 3-6) at last follow-up. SBP variability comparisons between good and poor groups were performed. Results: A total of 204 patients were identified. The mean age was 56.8 years; 66.2% of patients were female. Median follow-up time was 18 months. Fifty-nine (28.9%) patients had an mRS 3-6. On univariate analysis, predictors of poor outcome were: a lower mean SBP (p<0.01) and minimum SBP (p<0.01); a higher peak SBP (p=0.02) and through SBP (p=0.04); age (p<0.01), Hunt and Hess (p<0.01), modified Fisher (p=0.03), and aneurysmal management (p<0.01). A multivariate model was built with mean SBP (p=0.11), Hunt and Hess (p<0.01), surgical management (p<0.01), and endovascular management (p<0.01). A repeated measure analysis of SBP variability over time revealed no difference between functional outcome cohorts (Mean SBP p=0.63). Conclusion: Variability of SBP during the acute period of aSAH was not associated with functional outcomes at last follow-up.