High blood pressure may have no effect on acute TTP recovery

There appears to be no link between high blood pressure in the first two days after an acute episode of thrombotic thrombocytopenic purpura (TTP) and how well a patient recovers or remains in remission, when no symptoms occur for a time.

That’s according to a new study from researchers in France and Chile that indicates that strict blood pressure control for people with the rare blood disorder may not be necessary.

“Our findings do not support the need for strict blood pressure control in this setting,” the researchers wrote, adding that “prospective studies are needed to address whether aggressive blood pressure management could be associated with adverse effects.”

The study detailing these findings, titled “Longitudinal analysis of arterial pressure and its impact on outcomes in patients with thrombotic thrombocytopenic purpura,” was published as a letter in the journal Intensive Care Medicine.

Researchers reviewed records of 98 TTP patients admitted to ICU

TTP is caused by the lack or dysfunction of an enzyme called ADAMTS13. This enzyme normally prevents blood clots from forming when they aren’t needed. Without enough ADAMTS13, clots form in small blood vessels and block blood flow to organs, leading to symptoms that often arise suddenly.

Hypertension, or high blood pressure, can worsen TTP in the long term. However, its effects during an acute episode of TTP has not been studied.

To learn more, the research team reviewed the medical records of 98 people with TTP who were admitted to the intensive care unit (ICU) of Saint-Louis University Hospital in Paris between 2006 and 2020. In all patients, the activity of ADAMTS13 was lower than 10%.

Blood pressure was measured every six hours for the first two days after admission. Patients were divided into three groups, depending on their blood pressure trajectories: 38 had hypertension at admission that persisted; 36 had normal blood pressure at first, but then developed hypertension in the ICU; and 24 had normal blood pressure throughout.

At admission, all three groups had similar signs of organ damage, including in the kidneys and organs of the nervous system, the data showed. Their median Sequential Organ Failure Assessment (SOFA) scores, which doctors use to measure how well a person’s organs are functioning, were also similar.

No differences seen in hospital stay length regardless of blood pressure

The main goal of the study was to watch for differences in how many days patients remained alive and in remission 28 days, or about one month, after admission. However, the team found that the median number of days was similar in all three groups: 19, 21, and 18 days, respectively.

There also were no differences in how long patients survived or remained in remission, nor in how many relapses they experienced, according to the records. Relapses are episodes when symptoms suddenly worsen or reappear after a period of remission. The researchers also noted no differences in how many days each group of patients stayed in the hospital.

Overall, these findings suggest no need for strict blood pressure control after an acute episode of TTP, the team concluded.

However, the researchers noted that the number of patients studied was small. As such, “the prognostic impact of persistent versus transient hypertension among initially hypertensive patients could not be assessed … and warrants further investigation,” the team wrote.