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Inadequate BP control may increase risk for intracerebral hemorrhage recurrence
Among survivors of intracerebral hemorrhage, insufficient control of BP may be associated with increased risk for lobar and nonlobar hemorrhage recurrence, according to recent findings.
Researchers evaluated 1,145 participants in an ongoing, single-site cohort study of intracerebral hemorrhage (ICH). Patients were aged 18 years or older and were admitted to Massachusetts General Hospital between July 1994 and December 2011 with acute, CT scan-confirmed ICH. ICH location (lobar or nonlobar) was established at the time of incident event by investigators masked to clinical information.
Hemorrhage with selective involvement of the cerebral cortex, underlying white matter, or both was defined as lobar NCH; nonlobar ICH was defined as selective involvement of thalamus, basal ganglia or brain stem. Baseline data from prior to ICH were collected prospectively via in-person interview, and included information on demographics, medical history and previous drug exposure.
The ICH survivors were contacted for longitudinal follow-up at 3, 6, 9 and 12 months after index ICH and, subsequently, every 6 months (median, 36.8 months). At these time points, researchers collected imaging and medical records related to ICH recurrence, death and medication use/dosing. Additionally, they asked patients about their most recent ambulatory BP measurement acquired in a medical setting, and reviewed electronic medical records to acquire detailed information regarding medication use and recent clinical history. The main outcomes were incidence of recurrent ICH and whether the hemorrhage was lobar or nonlobar.
The researchers observed 102 recurrent ICH events among 505 lobar ICH survivors and 44 recurrent ICH events occurred among 640 survivors of nonlobar ICH. During follow-up, 54.6% of patients exhibited adequate BP control for at least one measurement, and 43.2% achieved consistent BP control. In patients with inadequate BP control, the lobar ICH event rate was 84 per 1,000 person-years compared with 49 per 1,000 person-years among those with adequate control.
Results from analyses modeling BP control as a time-varying variable indicated an association between inadequate BP control and increased risk for recurrence of lobar ICH (HR = 3.53; 95% CI, 1.65-7.54) and nonlobar ICH (HR = 4.23; 95% CI, 1.02-17.52). Researchers also observed associations between systolic BP and risk for lobar ICH recurrence (HR = 1.33; 95% CI, 1.02-1.76 per 10-mm Hg increase) and nonlobar ICH recurrence (HR = 1.54; 95% CI, 1.02-2.3). Diastolic BP was linked with increased risk for recurrence of nonlobar ICH (HR = 1.21; 95% CI, 1.01-1.47 per 10-mm Hg increment) but not lobar ICH (HR = 1.36; 95% CI, 0.9-2.1).
“In this observational single-center cohort study of ICH survivors, reported BP measurements suggesting inadequate BP control during follow-up were associated with higher risk of both lobar and nonlobar ICH recurrence,” the researchers wrote. “These data suggest that randomized clinical trials are needed to address the benefits and risks of stricter BP control in ICH survivors.” – by Jennifer Byrne
Disclosure: Several researchers report receiving support from the NIH-National Institute of Neurological Disorders and Stroke. One researcher reports receiving support from the Anne B. Young Fellowship in Therapeutic Development, which is partially sponsored by Biogen Idec Inc.