Multicenter Study

. 2018 Jul 3;91(1):e37-e44.

doi: 10.1212/WNL.0000000000005729. Epub 2018 Jun 6.

Hypertension and intracerebral hemorrhage recurrence among white, black, and Hispanic individuals

Axana Rodriguez-Torres¹, Meredith Murphy¹, Christina Kourkoulis¹, Kristin Schwab¹, Alison M Ayres¹, Charles J Moomaw¹, Soo Young Kwon¹, Jimmy V Berthaud¹, M Edip Gurol¹, Steven M Greenberg¹, Anand Viswanathan¹, Christopher D Anderson¹, Matthew Flaherty¹, Michael L James¹, Lee Birnbaum¹, Gene Yong Sung¹, Gunjan Parikh¹, Amelia K Boehme¹, Douglas Mayson¹, Kevin N Sheth¹, Chelsea Kidwell¹, Sebastian Koch¹, Michael Frankel¹, Carl D Langefeld¹, Fernando D Testai¹, Daniel Woo¹, Jonathan Rosand¹, Alessandro Biffi²

Affiliations

¹ From the University of California Irvine School of Medicine (A.R.-T.); Hemorrhagic Stroke Research Program (A.R.-T., M.M., C. Kourkoulis, K.S., A.M.A., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.), and Department of Neurology (A.R.-T., M.M., C. Kourkoulis, M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; Department of Neurology and Rehabilitation Medicine (C.J.M., S.Y.K., M. Flaherty, D.W.), University of Cincinnati, OH; Department of Neurology (J.V.B.), University of Virginia Medical Center, Charlottesville; Department of Neurology (M.L.J.), Duke University Hospital, Durham, NC; Department of Neurology and Neurosurgery (L.B.), University of Texas Health Science Center at San Antonio; Department of Neurology (G.Y.S.), Keck School of Medicine of University of Southern California, Los Angeles; Department of Neurology (G.P.), University of Maryland Medical Center, Baltimore; Department of Neurology (A.K.B.), Columbia University, New York, NY; Department of Neurology (D.M.), Georgetown University Medical Center, Washington, DC; Department of Neurology (K.N.S.), Yale University School of Medicine, New Haven, CT; Department of Neurology (C. Kidwell), University of Arizona College of Medicine, Tucson; Department of Neurology (S.K.), University of Miami Health System, FL; Department of Neurology (M. Frankel), Emory University School of Medicine, Atlanta, GA; Department of Biostatistical Sciences (C.D.L.), Wake Forest School of Medicine, Winston-Salem, NC; and Department of Neurology and Rehabilitation (F.D.T.), University of Illinois at Chicago College of Medicine.
² From the University of California Irvine School of Medicine (A.R.-T.); Hemorrhagic Stroke Research Program (A.R.-T., M.M., C. Kourkoulis, K.S., A.M.A., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.), and Department of Neurology (A.R.-T., M.M., C. Kourkoulis, M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; Department of Neurology and Rehabilitation Medicine (C.J.M., S.Y.K., M. Flaherty, D.W.), University of Cincinnati, OH; Department of Neurology (J.V.B.), University of Virginia Medical Center, Charlottesville; Department of Neurology (M.L.J.), Duke University Hospital, Durham, NC; Department of Neurology and Neurosurgery (L.B.), University of Texas Health Science Center at San Antonio; Department of Neurology (G.Y.S.), Keck School of Medicine of University of Southern California, Los Angeles; Department of Neurology (G.P.), University of Maryland Medical Center, Baltimore; Department of Neurology (A.K.B.), Columbia University, New York, NY; Department of Neurology (D.M.), Georgetown University Medical Center, Washington, DC; Department of Neurology (K.N.S.), Yale University School of Medicine, New Haven, CT; Department of Neurology (C. Kidwell), University of Arizona College of Medicine, Tucson; Department of Neurology (S.K.), University of Miami Health System, FL; Department of Neurology (M. Frankel), Emory University School of Medicine, Atlanta, GA; Department of Biostatistical Sciences (C.D.L.), Wake Forest School of Medicine, Winston-Salem, NC; and Department of Neurology and Rehabilitation (F.D.T.), University of Illinois at Chicago College of Medicine. abiffi@partners.org.

PMID: 29875221
PMCID: PMC6091878
DOI: 10.1212/WNL.0000000000005729

Multicenter Study

Hypertension and intracerebral hemorrhage recurrence among white, black, and Hispanic individuals

Axana Rodriguez-Torres et al. Neurology. 2018.

. 2018 Jul 3;91(1):e37-e44.

doi: 10.1212/WNL.0000000000005729. Epub 2018 Jun 6.

Authors

Affiliations

¹ From the University of California Irvine School of Medicine (A.R.-T.); Hemorrhagic Stroke Research Program (A.R.-T., M.M., C. Kourkoulis, K.S., A.M.A., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.), and Department of Neurology (A.R.-T., M.M., C. Kourkoulis, M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; Department of Neurology and Rehabilitation Medicine (C.J.M., S.Y.K., M. Flaherty, D.W.), University of Cincinnati, OH; Department of Neurology (J.V.B.), University of Virginia Medical Center, Charlottesville; Department of Neurology (M.L.J.), Duke University Hospital, Durham, NC; Department of Neurology and Neurosurgery (L.B.), University of Texas Health Science Center at San Antonio; Department of Neurology (G.Y.S.), Keck School of Medicine of University of Southern California, Los Angeles; Department of Neurology (G.P.), University of Maryland Medical Center, Baltimore; Department of Neurology (A.K.B.), Columbia University, New York, NY; Department of Neurology (D.M.), Georgetown University Medical Center, Washington, DC; Department of Neurology (K.N.S.), Yale University School of Medicine, New Haven, CT; Department of Neurology (C. Kidwell), University of Arizona College of Medicine, Tucson; Department of Neurology (S.K.), University of Miami Health System, FL; Department of Neurology (M. Frankel), Emory University School of Medicine, Atlanta, GA; Department of Biostatistical Sciences (C.D.L.), Wake Forest School of Medicine, Winston-Salem, NC; and Department of Neurology and Rehabilitation (F.D.T.), University of Illinois at Chicago College of Medicine.
² From the University of California Irvine School of Medicine (A.R.-T.); Hemorrhagic Stroke Research Program (A.R.-T., M.M., C. Kourkoulis, K.S., A.M.A., M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.), and Department of Neurology (A.R.-T., M.M., C. Kourkoulis, M.E.G., S.M.G., A.V., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; Department of Neurology and Rehabilitation Medicine (C.J.M., S.Y.K., M. Flaherty, D.W.), University of Cincinnati, OH; Department of Neurology (J.V.B.), University of Virginia Medical Center, Charlottesville; Department of Neurology (M.L.J.), Duke University Hospital, Durham, NC; Department of Neurology and Neurosurgery (L.B.), University of Texas Health Science Center at San Antonio; Department of Neurology (G.Y.S.), Keck School of Medicine of University of Southern California, Los Angeles; Department of Neurology (G.P.), University of Maryland Medical Center, Baltimore; Department of Neurology (A.K.B.), Columbia University, New York, NY; Department of Neurology (D.M.), Georgetown University Medical Center, Washington, DC; Department of Neurology (K.N.S.), Yale University School of Medicine, New Haven, CT; Department of Neurology (C. Kidwell), University of Arizona College of Medicine, Tucson; Department of Neurology (S.K.), University of Miami Health System, FL; Department of Neurology (M. Frankel), Emory University School of Medicine, Atlanta, GA; Department of Biostatistical Sciences (C.D.L.), Wake Forest School of Medicine, Winston-Salem, NC; and Department of Neurology and Rehabilitation (F.D.T.), University of Illinois at Chicago College of Medicine. abiffi@partners.org.

PMID: 29875221
PMCID: PMC6091878
DOI: 10.1212/WNL.0000000000005729

Abstract

Objective: To clarify whether recurrence risk for intracerebral hemorrhage (ICH) is higher among black and Hispanic individuals and whether this disparity is attributable to differences in blood pressure (BP) measurements and their variability.

Methods: We analyzed data from survivors of primary ICH enrolled in 2 separate studies: (1) the longitudinal study conducted at Massachusetts General Hospital (n = 759), and (2) the ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) study (n = 1,532). Participants underwent structured interview at enrollment (including self-report of race/ethnicity) and were followed longitudinally via phone calls and review of medical records. We captured systolic BP (SBP) and diastolic BP measurements, and quantified variability as SBP and diastolic BP variation coefficients. We used multivariable (Cox regression) survival analysis to identify risk factors for ICH recurrence.

Results: We followed 2,291 ICH survivors (1,121 white, 529 black, 605 Hispanic, and 36 of other race/ethnicity). Both black and Hispanic patients displayed higher SBP during follow-up (p < 0.05). Black participants also displayed greater SBP variability during follow-up (p = 0.032). In univariable analyses, black and Hispanic patients were at higher ICH recurrence risk (p < 0.05). After adjusting for BP measurements and their variability, both Hispanic (hazard ratio = 1.51, 95% confidence interval 1.14-2.00, p = 0.004) and black (hazard ratio = 1.98, 95% confidence interval 1.36-2.86, p < 0.001) patients remained at higher risk of ICH recurrence.

Conclusion: Black and Hispanic patients are at higher risk of ICH recurrence; hypertension severity (average BP and its variability) does not fully account for this finding. Additional studies will be required to further elucidate determinants for this health disparity.

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Figures

**Figure 1. SBP following ICH by race and ethnicity**
(A) Average SBP during follow-up after ICH, by self-reported race/ethnicity. (B) Average SBP variation (SD/mean) during follow-up, by self-reported race/ethnicity. Boxplot upper and lower margins indicate 25th and 75th percentiles of average SBP during follow-up (A) and average SBP variation (%) during follow-up (B). Horizontal lines in boxes indicate corresponding median values. ICH = intracerebral hemorrhage; SBP = systolic blood pressure.

**Figure 2. ICH recurrence by race and ethnicity**
Kaplan-Meier plot of ICH recurrence rates for white, black, and Hispanic study participants. ICH = intracerebral hemorrhage.

See this image and copyright information in PMC

References

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Hypertension and intracerebral hemorrhage recurrence among white, black, and Hispanic individuals

Affiliations

Hypertension and intracerebral hemorrhage recurrence among white, black, and Hispanic individuals

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical