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Neurocritical Care

, Volume 28, Issue 3, pp 344–352 | Cite as

Impact of Admission Hypertension on Rates of Acute Kidney Injury in Intracerebral Hemorrhage Treated with Intensive Blood Pressure Control

  • Hannah Hewgley
  • Stephen C. Turner
  • Joseph E. Vandigo
  • Jacob Marler
  • Heather Snyder
  • Jason J. Chang
  • G. Morgan Jones
Original Article
  • 311 Downloads

Abstract

Background

Current guidelines recommend that rapid systolic blood pressure (SBP) lowering to 140 mmHg may be considered in intracerebral hemorrhage (ICH) patients regardless of initial SBP. However, limited safety data exist in patients presenting with varying degrees of severe hypertension. The purpose of this study was to determine whether there was an increased risk of acute kidney injury (AKI) based upon degree of presentation hypertension in ICH patients whose blood pressure was reduced intensively.

Methods

This retrospective, cohort study evaluated ICH patients treated with intensive blood pressure control (SBP ≤140 mmHg) who presented with three degrees of presentation hypertension: mild (SBP 141–179 mmHg), moderate (SBP 180–219 mmHg), and severe (SBP ≥ 220 mmHg). Univariate analysis of demographics variables, ICH severity, and factors known to impact AKI was conducted between the three groups. Post hoc testing was used to compare differences between specific groups, with a Bonferroni correction adjusting for multiple comparisons. Additionally, we conducted logistic regression analysis to determine whether baseline SBP group independently predicted AKI.

Results

We included 401 patients (177 with mild, 124 with moderate, and 100 with severe hypertension). There was a significant increase in the prevalence of AKI between groups, with the severe group experiencing the highest rate (p < 0.001). The presence of severe hypertension was also found to independently predict AKI development (odds ratio 2.6; p < 0.001).

Conclusion

Our study observed higher rates of AKI in patients presenting with severe hypertension. Further research is needed to determine the most appropriate strategies for managing blood pressure in ICH patients presenting with higher SBP.

Keywords

Hypertension Acute kidney injury Intracerebral hemorrhage Blood pressure 

Notes

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Supplementary material

12028_2017_488_MOESM1_ESM.doc (70 kb)
Supplementary material 1 (DOC 69 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Hannah Hewgley
    • 1
  • Stephen C. Turner
    • 2
  • Joseph E. Vandigo
    • 3
  • Jacob Marler
    • 1
    • 2
  • Heather Snyder
    • 1
    • 2
  • Jason J. Chang
    • 4
  • G. Morgan Jones
    • 1
    • 5
  1. 1.Department of PharmacyMethodist University HospitalMemphisUSA
  2. 2.Department of Clinical PharmacyUniversity of Tennessee Health Sciences CenterMemphisUSA
  3. 3.Pharmaceutical Health Services Research DepartmentUniversity of Maryland School of PharmacyBaltimoreUSA
  4. 4.Department of Critical CareMedStar Washington Hospital Medical CenterWashingtonUSA
  5. 5.Department of Clinical Pharmacy, Neurology, and NeurosurgeryUniversity of Tennessee Health Sciences CenterMemphisUSA

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