Impact of Sustained Hypertension on Mortality in Patients With Traumatic Brain Injury

Introduction: Hypotension is a significant factor associated with increased mortality in patients with traumatic brain injuries (TBI). Trauma guidelines recommend maintaining a systolic blood pressure (SBP) of 110 mmHg for patients aged 15-49 or >70 and 100 mmHg for patients aged 50-69 to ensure adequate cerebral perfusion pressure. Guidelines do not specify an upper limit for SBP. A review of TBI patients from the IMPACT database evaluating outcomes to SBP and MAP found that optimal outcomes were achieved with SBP between 120-150 mmHg and SBP >150 mmHg was linked to poor outcomes. The primary objective of this study was to assess the relationship between sustained hypertension and mortality in patients with TBI.


Methods: This was an IRB approved, retrospective, single-center study that reviewed patients with a primary diagnosis of TBI from Nov 1, 2024, to Dec 31, 2024. Included patients at least 18 years of age, required ICU admission. Chi-square test for primary endpoints, mean and standard deviation for normally distributed data, median and interquartile range for non-normally distributed data. Statistics were performed using R Studio, posit team (2025): Integrated Development Environment for R. Posit Software, PBC, Boston, MA. Sustained HTN was defined as patients who required pharmacological intervention for HTN within the first 72 hours of admission.


Results: Fifty patients were included, 68.6% males, average age of 65.8 (SD ± 18.8), 74% of patients were white. Patients with a past medical history of HTN encompassed 52%. Primary mechanism of injury for most was falls (60.8%), 58.8% of patients had a mild TBI based on Glasgow Coma Score (GCS), followed by 31.4% of patients with severe TBI. For primary outcome, when comparing mortality in the sustained vs non-sustained HTN groups, there was only 8% mortality in the sustained HTN vs 16% in the non-sustained HTN, not statistically significant. When comparing mortality in TBI subtypes, results between both groups were not statistically significant. When comparing mortality in patients who required neurosurgical intervention, results between both groups were not statistically significant.


Conclusions: Due to small sample size and preliminary results, conclusions cannot be drawn regarding the impact of sustained hypertension in TBI patients.