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. 2022 Sep;7(3):280-288.
doi: 10.1177/23969873221094412. Epub 2022 Apr 27.

Lobar intracerebral hemorrhage and risk of subsequent uncontrolled blood pressure

Evangelos Pavlos Myserlis  1   2   3   4 , Ernst Mayerhofer  1   2   3   4 , Jessica R Abramson  1   2   3   4 , Kay-Cheong Teo  5 , Bailey E Montgomery  1   2   3   4 , Lansing Sugita  1   2   4 , Andrew D Warren  2 , Joshua N Goldstein  6 , Mahmut Edip Gurol  2 , Anand Viswanathan  2 , Steven M Greenberg  2 , Alessandro Biffi  2   4 , Christopher D Anderson  1   2   3   4   7 , Jonathan Rosand  1   2   3   4
Affiliations

Lobar intracerebral hemorrhage and risk of subsequent uncontrolled blood pressure

Evangelos Pavlos Myserlis et al. Eur Stroke J. 2022 Sep.

Abstract

Background: Uncontrolled blood pressure (BP) in intracerebral hemorrhage (ICH) survivors is common and associated with adverse clinical outcomes. We investigated whether characteristics of the ICH itself were associated with uncontrolled BP at follow-up.

Methods: Subjects were consecutive patients aged ⩾18 years with primary ICH enrolled in the prospective longitudinal ICH study at Massachusetts General Hospital between 1994 and 2015. We assessed the prevalence of uncontrolled BP (mean BP ⩾140/90 mmHg) 6 months after index event. We used multivariable logistic regression models to assess the effect of hematoma location, volume, and event year on uncontrolled BP.

Results: Among 1492 survivors, ICH was lobar in 624 (42%), deep in 749 (50%), cerebellar in 119 (8%). Lobar ICH location was associated with increased risk for uncontrolled BP after 6 months (OR 1.35; 95% CI [1.08-1.69]). On average, lobar ICH survivors were treated with fewer antihypertensive drugs compared to the rest of the cohort: 2.1 ± 1.1 vs 2.5 ± 1.2 (p < 0.001) at baseline and 1.8 ± 1.2 vs. 2.4 ± 1.2 (p < 0.001) after 6 months follow-up. After adjustment for the number of antihypertensive drugs prescribed, the association of lobar ICH location with risk of uncontrolled BP was eliminated.

Conclusions: ICH survivors with lobar hemorrhage were more likely to have uncontrolled BP after 6 months follow-up. This appears to be a result of being prescribed fewer antihypertensive medications. Future treatment strategies should focus on aggressive BP control after ICH independent of hemorrhage location.

Keywords: Blood pressure; Hypertension; Intracerebral hemorrhage; Stroke.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Study flow chart. ICH, Intracerebral Hemorrhage; CT, Computed Tomography; BP, Blood Pressure.
Figure 2.
Figure 2.
Differences in ICH volume and distribution of controlled, undertreated, and resistant blood pressure after 6 months follow-up by ICH location. (a) ICH volume by location with significantly higher volumes among patients with lobar hemorrhage compared to those with non-lobar hemorrhage. ICH volume was measured for 1326 (88.9%) patients. (b) Distribution of blood pressure control among the 779 (52.2%) patients with available blood pressure and antihypertensive drug prescription data after 6 months follow-up. Lobar ICH patients had a higher fraction of undertreated and non-lobar ICH patients a higher fraction of resistant hypertension. Controlled hypertension was defined as systolic <140 mmHg and diastolic <90 mmHg according to the AHA/ASA recommendations during our study. If hypertension was not controlled, having ⩾3 antihypertensive agents was defined as resistant and ⩽2 antihypertensive agents as undertreated hypertension.
See this image and copyright information in PMC

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