ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2025
Time-varying association between blood pressure and malignant brain edema after large hemispheric infarction: a prospective cohort study.
Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimTo investigate the time-varying association between blood pressure (BP) and malignant brain edema (MBE) risk after large hemispheric infarction (LHI).
methodsWe prospectively enrolled LHI patients (CT hypodensity > 1/3 middle cerebral artery territory within 6 h or > 1/2 within 6-48 h of onset) from registry cohort. BP was recorded hourly and analyzed for 24 h and in two 12-hour epochs after onset: 1-12 h and 13-24 h. MBE was defined as neurological deterioration symptoms with midline shift ≥ 5 mm. Generalized estimating equation (GEE) compared BP patterns by MBE occurrence. Logistic regression and restricted cubic splines (RCS) assessed dose-response associations.
resultsAmong 414 included LHI patients (mean age 69 ± 14y, median onset-to-admission interval 3 h [interquartile range, IQR 2-5]), 117(28.3%) developed MBE with a median post-onset interval of 29 h (IQR 15-56). No significant difference in BP level was observed during 1-12 h. Systolic BP (SBP) was significantly higher in MBE group over time during 13-24 h (GEE P = 0.027). The 24-hour mean SBP exhibited a U-shaped association with MBE risk (nonlinear test, P = 0.029), with no significance in 1-12 h and a positive correlation between mean SBP in 13-24 h and MBE risk (aOR 1.02[1.00-1.04]). A threshold effect for 24-hour mean diastolic BP (DBP) was identified (non-linear test, P = 0.039), with DBP increase above 70 mmHg associated with higher MBE risk (aOR 1.03 [1.00-1.07]). Similarly, elevated mean DBP > 75mmHg during 1-12 h was associated with higher MBE risk.
conclusionIn LHI patients, 24-hour mean SBP demonstrated a U-shaped association with MBE risk, with no significant effect during 1-12 h and a positive linear correlation during 13-24 h after onset. DBP exhibited a threshold effect, primarily influencing MBE risk during 1-12 h after onset.
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