Alessandro Biffi|Chris Anderson|Thomas W.K. Battey|Alison Ayres|Steven M. Greenberg|Anand Viswanathan|Jonathan Rosand
Association Between Blood Pressure Control and Risk of Recurrent Intracerebral Hemorrhage
Center for Human Genetics|Massachusetts General Hospital|Center for Human Genetics|Massachusetts General Hospital|Center for Human Genetics|Massachusetts General Hospital|Massachusetts General Hospital|Massachusetts General Hospital|Massachusetts General Hospital|Center for Human Genetics|Massachusetts General Hospital|Broad Institute
importance intracerebral hemorrhage ich severe form strokesurvivors high risk recurrence death worsening functional disabilityobjective investigate association blood pressure bp index ich risk recurrent ichdesign setting participants singlesite tertiary care referral center observational study 1145 2197 consecutive patients ich presenting july 1994 december 2013a total 1145 patients ich survived least 90 days followed december 2013 median followup 368 months minimum 98 monthsexposures blood pressure measurements 3 6 9 12 months every 6 months thereafter obtained medical personnel inpatient hospital outpatient clinic medical nursing staff via patient selfreportexposure characterized 3 ways 1 recorded systolic diastolic measurements 2 classification adequate inadequate bp control based american heart associationamerican stroke association recommendations and3 stage hypertension based joint national committee prevention detection evaluation treatment high blood pressure 7 criteria main outcomes measures recurrent ich location within brain lobar vs nonlobarresults 102 recurrent ich events among 505 survivors lobar ich 44 recurrent ich events among 640 survivors nonlobar ichduring followup adequate bp control achieved least 1 measurement 625 patients 546 total range 492587and consistently ie available time points 495 patients 432 total range 345510the event rate lobar ich 84 per 1000 personyears among patients inadequate bp control compared 49 per 1000 personyears among patients adequate bp controlfor nonlobar ich event rate 52 per 1000 personyears inadequate bp control compared 27 per 1000 personyears patients adequate bp controlin analyses modeling bp control timevarying variable inadequate bp control associated higher risk recurrence lobar ich hazard ratio hr 353 95 ci 165754and nonlobar ich hr 423 95 ci 1021752systolic bp followup associated increased risk lobar ich recurrence hr 133 per 10mm hg increase 95 ci 102176and nonlobar ich recurrence hr 154 95 ci 103230diastolic bp associated increased risk nonlobar ich recurrence hr 121 per 10mm hg increase 95 ci 101147but lobar ich recurrence hr 136 95 ci 090210 conclusions relevancein observational singlecenter cohort study ich survivors reported bp measurements suggesting inadequate bp control followup associated higher risk lobar nonlobar ich recurrencethese data suggest randomized clinical trials needed address benefits risks stricter bp control ich survivors