(694) Blood Pressure Variability in Patient Receiving Bolus Versus Continuous Infusion Antihypertensives

Introduction: Blood pressure variability (BPV) is associated with poor neurological outcomes in patients with ischemic or hemorrhagic stroke suggesting antihypertensive regimens should be selected which minimize BPV. This study sought to determine if intravenous (IV) bolus, continuous infusion or a combination of regimens are associated with decreased BPV and neurological deterioration.

Methods: Patients presenting with acute ischemic stroke (AIS), intracranial hemorrhage (ICH) or aneurysmal subarachnoid hemorrhage (aSAH) who required IV antihypertensives to meet blood pressure goal were included. Patients were grouped based on receipt of antihypertensives as IV bolus, continuous infusion or a combination of both. All systolic and diastolic blood pressure (SBP, DBP) measures were collected for the first 24 hrs post neurologic event. BPV was calculated using average real variability (ARV), SBP, DBP and mean arterial pressure (MAP). The primary outcome was neurologic decline within 24 hrs of antihypertensive initiation, defined as increase in NIHSS > 4 or decrease in Glasgow Coma Scale > 2 (GCS). BPV was compared between groups using Kruskal-Wallis test.

Results: 625 patients met inclusion criteria; 292 (46.7%) received bolus only, 158 (25.3%) continuous infusion and 175 (28%) bolus + infusion. 265 (42.4%) patients presented with AIS, 249 (39.8%) with ICH and 111 (17.8%) with aSAH. Baseline characteristics were similar between groups with median NIHSS 10 (4, 20) and GCS 14 (10, 15) on arrival. BPV measured by ARV in the first 24 hrs differed in the 3 groups across SBP, DBP and MAP (p < 0.05), with the greatest ARV in the bolus group. Neurologic decline was assessed in 78.6% of patients. GCS deterioration occurred more frequently in the combination group (37.6%) versus bolus (25%) or continuous infusion groups (26.8%, p=0.012). NIHSS increase occurred most frequently in the combination group (20.9% vs 15.6%, 13.5%, p=0.001).

Conclusions: Bolus IV antihypertensive were associated with increased BPV compared to other regimens. Neurological deterioration occurred more frequently in the combination group. Based on preliminary analysis, continuous infusion IV antihypertensives appear to be the preferred regimen for BP management in this population.