Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 28;3(1):202.
doi: 10.4102/jcmsa.v3i1.202. eCollection 2025.

A 60% crisis: Mortality and hypertension-driven intracranial haemorrhage at a South African tertiary hospital

Umar Jacobs  1 , Thaakir-Ahmed Jacobs  2 , Janneke Pienaar  1 , Sideeqa Jakoet  2 , Aaqilah Fataar  3 , Neshaad Schrueder  1 , Sa'ad Lahri  4
Affiliations

A 60% crisis: Mortality and hypertension-driven intracranial haemorrhage at a South African tertiary hospital

Umar Jacobs et al. J Coll Med S Afr. .

Abstract

Background: Spontaneous intracranial haemorrhage (ICH) is a significant cause of morbidity and mortality worldwide, with a disproportionate burden in low- and middle-income countries. Data on ICH in South Africa are limited, hindering targeted intervention efforts.

Methods: A retrospective, descriptive study was conducted at Tygerberg Hospital, Cape Town, reviewing records of patients with confirmed spontaneous ICH based on computed tomography imaging from 01 January 2021 to 31 December 2022. Demographics, risk factors, clinical presentation, imaging findings and outcomes were analysed.

Results: Of the 162 eligible cases, 53.09% were male, with a mean age of 51.81 years (standard deviation: 11.88). Hypertension was the most prevalent risk factor (87.04%), with 84.57% presenting with grade 2 hypertension on admission. Basal ganglia involvement was the most common ICH location (55.56%). Complications were frequent, with 79.82% showing intraventricular extension. The 3-month and 1-year mortality rates were 59.88% and 60.49%, respectively. Only 57.41% of hypertensive patients were on antihypertensive medication prior to ICH.

Conclusion: This study highlights the significant burden of spontaneous ICH in a South African tertiary hospital setting, characterised by a younger age of onset and high prevalence of modifiable risk factors, particularly uncontrolled hypertension. These findings underscore the urgent need for enhanced hypertension management and targeted primary prevention strategies to reduce the ICH burden, providing valuable data to inform public health interventions in resource-limited settings.

Contribution: This study provides data on spontaneous intracranial hemorrhage (ICH) in a South African tertiary hospital, identifying a high mortality rate and the prevalence of uncontrolled hypertension in a younger population. The findings address a key data scarcity in low- and middle-income countries and promote the development of tailored prevention and management initiatives, which are consistent with the journal's emphasis on regionally appropriate, evidence-based healthcare interventions.

Keywords: CT scan results; age; blood pressure on admission; clinical outcome of patient; gender; risk factors and comorbidities; use of antiplatelet and anticoagulation medication.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article. The author, S.L., serves as an editorial board member of this journal. S.L. has no other competing interests to declare.

Figures

FIGURE 1
FIGURE 1
Risk factors associated with spontaneous intracranial haemorrhage.
FIGURE 2
FIGURE 2
Distribution of medication usage in patients with ICH.
FIGURE 3
FIGURE 3
Kaplan–Meier survival curve.
None
See this image and copyright information in PMC

References

    1. Greenberg SM, Ziai WC, Cordonnier C, et al. 2022 Guideline for the management of patients with spontaneous intracerebral hemorrhage: A guideline from the American Heart Association/American Stroke Association. Stroke. 2022;53(7):e282–e361. 10.1161/STR.0000000000000407 - DOI - PubMed
    1. De Oliveira Manoel AL, Goffi A, Zampieri FG, et al. The critical care management of spontaneous intracranial hemorrhage: A contemporary review. Crit Care. 2016;20(1):272. 10.1186/s13054-016-1432-0 - DOI - PMC - PubMed
    1. Sheth KN. Spontaneous intracerebral hemorrhage. N Engl J Med. 2022;387(17):1589–1596. 10.1055/s-0030-1268865 - DOI - PubMed
    1. Ruff IM, De Havenon A, Bergman DL, et al. 2024 AHA/ASA performance and quality measures for spontaneous intracerebral hemorrhage: A report from the American Heart Association/American Stroke Association. Stroke. 2024;55(7):e199–e230. 10.1161/STR.0000000000000464 - DOI - PubMed
    1. Krishnamurthi RV, Feigin VL, Forouzanfar MH, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010: Findings from the Global Burden of Disease Study 2010. Lancet Glob Health. 2013;1(5):e259–e281. 10.1016/S2214-109X(13)70089-5 - DOI - PMC - PubMed

LinkOut - more resources