Journal Article

Time‐Dependent Association Between Prehospital Blood Pressure and Outcomes in Acute Spontaneous Intracerebral Hemorrhage

Weng, Tzu‐Hsuan, Tu, Yu‐Kang, Hsieh, Ming‐Ju, Wang, Jui, Jeng, Jiann‐Shing, Tsai, Li‐Kai, Lien, Chun‐Ju, Chen, Chih‐Hao, Ko, Ying‐Chih, Tang, Sung‐Chun

2026

Overview

Background Elevated blood pressure (BP) after spontaneous intracerebral hemorrhage (ICH) is associated with poor outcomes, but the prognostic value of prehospital BP, particularly in relation to onset‐to‐arrival time, remains unclear. We investigated time‐dependent associations of prehospital BP, arrival BP, and their early difference with in‐hospital outcomes. Methods We conducted a retrospective cohort study using a prospectively maintained stroke registry at a tertiary medical center in Taipei, Taiwan (2016–2022). Adults (≥ 18 years) with spontaneous ICH transported by emergency medical services within 24 h of symptom onset and with available prehospital BP were included. First prehospital and hospital‐arrival BP were analyzed. Outcomes were in‐hospital mortality and stroke in evolution (SIE) within 72 h of hospital admission. Patients were stratified by onset‐to‐arrival time (< 3 vs. ≥ 3 h). Multivariable logistic regression and restricted cubic splines were applied. Results Six hundred ninety patients were included (mean age 64.7 years, 63.1% male; 336 < 3 h, 354 ≥ 3 h). In patients arriving ≥ 3 h, higher prehospital systolic BP, mean arterial pressure, and pulse pressure were independently associated with increased odds of in‐hospital mortality, and higher arrival pulse pressure was also associated with mortality. Associations with SIE and early BP differences were weaker and were attenuated in fully adjusted models. Restricted cubic spline showed no nonlinear associations. No significant associations between BP measures and outcomes were observed in patients arriving < 3 h. Conclusions Higher prehospital BP was associated with increased in‐hospital mortality among patients presenting ≥ 3 h after onset, whereas such associations are not evident within 3 h. This study, involving 690 adult patients with spontaneous intracerebral hemorrhage, showed that higher prehospital systolic blood pressure, mean arterial pressure, and pulse pressure were independently associated with in‐hospital mortality. In addition, higher pulse pressure on arrival was also associated with mortality. However, these associations were not observed in patients who arrived within 3 h.

• Publisher: John Wiley & Sons, Inc,Wiley
• Subject: Aged / Blood Pressure / Blood Pressure Determination / Cerebral Hemorrhage - diagnosis / Cerebral Hemorrhage - mortality / Cerebral Hemorrhage - physiopathology / Emergency medical care / emergency medical service / Emergency medical services / Female / Health services / Hemorrhage / Hospital Mortality / Hospitals / Humans / Hypertension / intracerebral hemorrhage / in‐hospital mortality / Magnetic resonance imaging / Male / Middle Aged / Mortality / Original / Patients / prehospital blood pressure / Prognosis / Retrospective Studies / Stroke / Stroke - diagnosis / Stroke - mortality / Stroke - physiopathology / stroke in evolution / Taiwan - epidemiology / Tertiary Health Care / Time dependence / Time Factors / time to hospital arrival