Study Reveals Importance of Blood Pressure Control During Intensive Care for Patients with Neurologic Injuries

Maintaining normal blood pressure is one of the most effective ways of preventing a second stroke or other neurologic injury, according to a new study by investigators from Mass General Brigham. Researchers found that among patients who had experienced these types of brain injuries, failing to achieve good blood pressure control during intensive care was linked to a higher likelihood of having long-term hypertension, putting them at a high risk for future strokes or neurologic injury. The findings are described in a study published in Neurology Clinical Practice. 

“Many patients admitted to the Neuroscience Intensive Care Unit, or NeuroICU, with acute neurologic injuries have very difficult-to-control blood pressure,” said co-author Jonathan Rosand, MD, MSC, the co-founder of the Henry and Allison McCance Center for Brain Health and the J.P. Kistler Endowed Chair in Neurology at Massachusetts General Hospital (MGH). “But controlling blood pressure in the NeuroICU could set patients up for success for outpatient blood pressure control, which can substantially prolong brain health and reduce risk of dementia, stroke and depression.” 

The researchers, led by co-first authors Megan Kennelly, DNP, AGACNP-BC, RN, Andrew J. Webb, PharmD, BCCCP, and Sophie Ack, BS, assessed outcomes for patients who did or did not achieve blood pressure targets before leaving the NeuroICU. Among 10,836 adults at Brigham and Women’s Hospital and MGH in 2016–2022, 28.3% were hypertensive at hospital discharge. Patients with hypertension at NeuroICU transfer were more likely to remain hypertensive at discharge than those with normal blood pressure (52% versus 17%). Each 10-mm Hg systolic blood pressure increase at transfer was associated with 60% higher chance of uncontrolled hypertension at discharge, persisting through 2 years of follow-up, regardless of’ initial diagnoses and medical histories. 

“Our work highlights that a patient’s stay in the hospital is a critical period for achieving long-term blood pressure control,” said the study’s senior author Eric Rosenthal, MD, director of the MGH Neurosciences Intensive Care Unit and program director of the MGB NeuroAI Center. “While we are providing intensive and hospital care, we have the role to provide primary care as well, and setting this course can influence years of cardiovascular and cerebrovascular health for a patient going forward.” 

Authorship: In addition to Rosand, Rosenthal, Kennelly, and Webb, Mass General Brigham authors include Gloria Hyunjung Kwak.

Disclosures: Webb has received consulting fees from Acasti Pharma, Inc. Rosand has received consulting fees from the National Football League and has received research grants from NIH (U01NS036695, R24NS092983, R01NS093870, R01NS100417, T32NS100663) and the American Heart Association (812095). Rosenthal has received research grants from DoD (W81XWH-18-DMRDP-PTCRA) and NIH (R01NS117904, K23NS105950, R01NS113541, U54NS100064, OT2OD032701). The remaining authors declare that they do not have any potential conflicts of interest. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

Funding: This study was funded by Real-Time Prediction of Delayed Cerebral Ischemia after Subarachnoid Hemorrhage [NIH/NIDS K23NS105950] and Bridge2AI: Patient-Focused Collaborative Hospital Repository Uniting Standards (CHoRUS) for Equitable AI [NIH/OD OT2OD032701] and NIH R01 NS093870.

Paper cited: Kennelly M et al. “Practice-Pattern Variation in Neurocritical Care Blood Pressure Control Reveals Opportunities for Improved Long-Term Hypertension Control” Neurol Clin Pract. DOI: 10.1212/CPJ.0000000000200453