J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 12, Number 11, November 2020, pages 693-698

Relationship Between Blood Pressure Levels on Admission and the Onset of Acute Pneumonia in Elderly Patients With Cerebral Hemorrhage

**Table 1.** Clinical Background at the Time of Hospitalization
	Pneumonia group (n = 30)	Non-pneumonia group (n = 87)	P value
Mann-Whitney U test, χ² test. *P < 0.1. BMI: body mass index; JCS: Japan Coma Scale; CRP: C-reactive protein; ARB: angiotensin II receptor blocker; ACEI: angiotensin-converting enzyme inhibitor; CCB: calcium channel blocker.
Age (years old)	81.7 ± 8.7	78.7 ± 7.0	0.059*
Sex (male/female)	14:16	44:43	0.833
BMI (kg/m²)	21.4 ± 3.1	21.6 ± 4.0	0.793
Imaging site diagnosis
Subcortical hemorrhage, n (%)	11 (36.7)	26 (29.9)	0.502
Thalamic hemorrhage, n (%)	10 (33.3)	27 (31.0)	0.823
Basal ganglia hemorrhage, n (%)	6 (20.0)	22 (25.3)	0.628
Bridge brain stem hemorrhage, n (%)	2 (6.7)	2 (2.3)	0.275
Cerebellar hemorrhage, n (%)	1 (3.3)	10 (11.5)	0.285
Bleeding amount (mL), n (%)	32.8 ± 43.7	15.1 ± 26.5	0.028*
Midline shift, n (%)	16 (53.3)	19 (21.8)	0.002*
Blood pressure levels on admission
Maximum systolic blood pressure (mm Hg)	194 ± 21	176 ± 24	< 0.001*
Maximum diastolic blood pressure (mm Hg)	105 ± 16	93 ± 14	< 0.001*
Pulse pressure (mm Hg)	89 ± 18	83 ± 21	0.098*
JCS (0 - 9)	5.3 ± 2.7	2.2 ± 3.1	< 0.001*
White blood cells (× 10⁹/L)	10.4 ± 3.9	7.7 ± 3.1	< 0.001*
CRP (mg/dL)	4.56 (0.1 - 40.1)	1.83 (0.1 - 26.4)	< 0.001*
Serum albumin (g/dL)	3.36 ± 0.56	3.74 ± 0.52	0.001*
History of stroke, n (%)	6 (20.0)	18 (20.7)	0.936
Heart disease, n (%)	5 (16.7)	14 (16.1)	0.941
Chronic kidney disease, n (%)	11 (36.7)	27 (31.0)	0.598
Diabetes, n (%)	6 (20.0)	6 (6.9)	0.074*
Dyslipidemia, n (%)	4 (13.3)	10 (11.5)	0.79
Pre-hypertension, n (%)	18 (60.0)	52 (59.8)	0.982
Previously-untreated hypertension, n (%)	6 (20.0)	13 (14.9)	0.517
Previous administration of antihypertensives, n (%)	12 (40.0)	39 (44.8)	0.646
ARB only, n (%)	5 (16.7)	11 (12.7)	0.58
ACEI only, n (%)	0 (0)	1 (1.1)	0.555
CCB only, n (%)	2 (6.7)	10 (11.5)	0.452
Thiazide only, n (%)	1 (3.3)	1 (1.1)	0.426
Beta-blockers only, n (%)	0 (0)	1 (1.1)	0.555
Combination of two or more antihypertensives, n (%)	4 (13.3)	15 (17.2)	0.617

Table 1. Clinical Background at the Time of Hospitalization

Pneumonia group (n = 30)

Non-pneumonia group (n = 87)

P value

Mann-Whitney U test, χ² test. *P < 0.1. BMI: body mass index; JCS: Japan Coma Scale; CRP: C-reactive protein; ARB: angiotensin II receptor blocker; ACEI: angiotensin-converting enzyme inhibitor; CCB: calcium channel blocker.

Age (years old)

81.7 ± 8.7

78.7 ± 7.0

0.059*

Sex (male/female)

14:16

44:43

0.833

BMI (kg/m²)

21.4 ± 3.1

21.6 ± 4.0

0.793

Imaging site diagnosis

Subcortical hemorrhage, n (%)

11 (36.7)

26 (29.9)

0.502

Thalamic hemorrhage, n (%)

10 (33.3)

27 (31.0)

0.823

Basal ganglia hemorrhage, n (%)

6 (20.0)

22 (25.3)

0.628

Bridge brain stem hemorrhage, n (%)

2 (6.7)

2 (2.3)

0.275

Cerebellar hemorrhage, n (%)

1 (3.3)

10 (11.5)

0.285

Bleeding amount (mL), n (%)

32.8 ± 43.7

15.1 ± 26.5

0.028*

Midline shift, n (%)

16 (53.3)

19 (21.8)

0.002*

Blood pressure levels on admission

Maximum systolic blood pressure (mm Hg)

194 ± 21

176 ± 24

< 0.001*

Maximum diastolic blood pressure (mm Hg)

105 ± 16

93 ± 14

< 0.001*

Pulse pressure (mm Hg)

89 ± 18

83 ± 21

0.098*

JCS (0 - 9)

5.3 ± 2.7

2.2 ± 3.1

< 0.001*

White blood cells (× 10⁹/L)

10.4 ± 3.9

7.7 ± 3.1

< 0.001*

CRP (mg/dL)

4.56 (0.1 - 40.1)

1.83 (0.1 - 26.4)

< 0.001*

Serum albumin (g/dL)

3.36 ± 0.56

3.74 ± 0.52

0.001*

History of stroke, n (%)

6 (20.0)

18 (20.7)

0.936

Heart disease, n (%)

5 (16.7)

14 (16.1)

0.941

Chronic kidney disease, n (%)

11 (36.7)

27 (31.0)

0.598

Diabetes, n (%)

6 (20.0)

6 (6.9)

0.074*

Dyslipidemia, n (%)

4 (13.3)

10 (11.5)

0.79

Pre-hypertension, n (%)

18 (60.0)

52 (59.8)

0.982

Previously-untreated hypertension, n (%)

6 (20.0)

13 (14.9)

0.517

Previous administration of antihypertensives, n (%)

12 (40.0)

39 (44.8)

0.646

ARB only, n (%)

5 (16.7)

11 (12.7)

0.58

ACEI only, n (%)

0 (0)

1 (1.1)

0.555

CCB only, n (%)

2 (6.7)

10 (11.5)

0.452

Thiazide only, n (%)

1 (3.3)

1 (1.1)

0.426

Beta-blockers only, n (%)

0 (0)

1 (1.1)

0.555

Combination of two or more antihypertensives, n (%)

4 (13.3)

15 (17.2)

0.617

**Table 2.** Independent Risk Factors for Acute Pneumonia
	Ward	Odds ratio	95% confidence interval	P value
*Multiple logistic regression analysis, P < 0.05. CRP: C-reactive protein; JCS: Japan Coma Scale.
Log(CRP) (mg/dL)	6.96	3.23	1.35 - 7.72	0.008*
Blood pressure on admission 4 classifications	5.94	2.4	1.19 - 4.85	0.015*
White blood cells (× 10⁹/L)	4.3	1.21	1.01 - 1.45	0.038*
JCS (0 - 9)	4.27	1.3	1.01 - 1.66	0.039*
Diabetes	2.72	4.12	0.77 - 22.2	0.099
Age (1 year old)	2.23	1.07	0.98 - 1.18	0.135
Serum albumin (g/dL)	2.19	0.4	0.12 - 1.35	0.139
Bleeding amount (mL)	0.81	0.99	0.97 - 1.01	0.368
Midline shift	0.65	0.53	0.12 - 2.48	0.421
Men	0.44	1.53	0.43 - 5.45	0.509

Table 2. Independent Risk Factors for Acute Pneumonia

Ward

Odds ratio

95% confidence interval

P value

*Multiple logistic regression analysis, P < 0.05. CRP: C-reactive protein; JCS: Japan Coma Scale.

Log(CRP) (mg/dL)

6.96

3.23

1.35 - 7.72

0.008*

Blood pressure on admission 4 classifications

5.94

2.4

1.19 - 4.85

0.015*

White blood cells (× 10⁹/L)

4.3

1.21

1.01 - 1.45

0.038*

JCS (0 - 9)

4.27

1.3

1.01 - 1.66

0.039*

Diabetes

2.72

4.12

0.77 - 22.2

0.099

Age (1 year old)

2.23

1.07

0.98 - 1.18

0.135

Serum albumin (g/dL)

2.19

0.4

0.12 - 1.35

0.139

Bleeding amount (mL)

0.81

0.99

0.97 - 1.01

0.368

Midline shift

0.65

0.53

0.12 - 2.48

0.421

Men

0.44

1.53

0.43 - 5.45

0.509

**Table 3.** Relationship Between Acute Pneumonia and Various Blood Pressure Groups on Admission
Blood pressure on admission	N	The number of patients with pneumonia	Odds ratio	95% confidence interval	P value
Multiple logistic regression analysis adjusted by age, sex, bleeding amount, midline shift, JCS, white blood cell count, log (CRP), serum albumin, and diabetes. CRP: C-reactive protein; JCS: Japan Coma Scale.
Normal blood pressure/mild hypertension group	22	1	1
Moderate hypertension group	33	6
Severe hypertension group	31	5
Serious hypertension group	31	18	5.54	1.49 - 20.6	0.011

Table 3. Relationship Between Acute Pneumonia and Various Blood Pressure Groups on Admission

Blood pressure on admission

The number of patients with pneumonia

Odds ratio

95% confidence interval

P value

Multiple logistic regression analysis adjusted by age, sex, bleeding amount, midline shift, JCS, white blood cell count, log (CRP), serum albumin, and diabetes. CRP: C-reactive protein; JCS: Japan Coma Scale.

Normal blood pressure/mild hypertension group

Moderate hypertension group

Severe hypertension group

Serious hypertension group

5.54

1.49 - 20.6

0.011