Prognostic value of blood pressure and its variability on the risk of hemorrhagic stroke in adult patients on anticoagulant therapy in Catalonia. A case-control study.

Joan De Montserrat Moreno, Ernest Vinyoles Bargalló, Núria Soldevila Bacardit, Clara Puig Pera, Miguel Angel Muñoz Pérez, Xavier Mundet Tudurí

Keywords: Intracranial Hemorrhages; Hemorrhagic stroke; Blood Pressure Determination; Blood Pressure Variability; Anticoagulants

Background:

Hemorrhagic stroke represents approximately 15% of all strokes. The combination of poor blood pressure control, high blood pressure variability, associated with anticoagulant therapy can multiply the risk.

Research questions:

How does the blood pressure control and its variability impact on the risk of hemorrhagic stroke on anticoagullated patients in Catalonia?

Method:

Case-control study in a population treated at primary care in Catalonia on anticoagulant treatment with history of an hemorrhagic stroke. Two comparable controls will be selected for each case. The data will be extracted from the shared medical records of Catalonia and the hospital admission registry. We will perform validation of the predictive model in a region of Catalonia.
We will determinate: average SBP and its variability will be measured with standard deviation, average real variability and coefficient of variation using data recorded during the previous 18 months. In addition to other risk factors for hemorrhagic stroke.
Statistical analysis: multivariate logistic regression models adjusted for hemorrhagic stroke risk factors will be used.

Results:

We estimate to include 890 cases of anticoagulated patients with hemorrhagic stroke in Catalonia, between 2006 and 2020. It is expected to find an association between poor SBP control and high variability on its values on the incidence of hemorrhagic stroke.

Conclusions:

The risk algorithm of this study will make possible to apply these new findings in in a pragmatic way at daily clinical practice by translating them into a computer application.

Points for discussion:

Does blood pressure variability increase the risk of having a hemorrhagic stroke in anticoagulated patients?

Does poor blood pressure control increase the risk of having a hemorrhagic stroke in anticoagulated patients?

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