Inadequate BP Control Associated With Increased Risk of ICH Recurrence
CHICAGO — September 1, 2015 — Survivors of an intracerebral haemorrhage (ICH) who had inadequate blood pressure (BP) control during follow-up had a higher risk of ICH recurrence, with this association appearing stronger with worsening severity of hypertension, according to a study published in the September 1 issue of JAMA.
Jonathan Rosand, MD, Massachusetts General Hospital, Boston, Massachusetts, and colleagues sought to determine whether BP reduction and control are associated with risk of recurrence of lobar or non-lobar ICH. The study included 1,145 patients with ICH who survived at least 90 days and were followed through December 2013 (median follow-up, 37 months). Blood pressure measurements were obtained at 3, 6, 9, and 12 months, and every 6 months thereafter from medical personnel or patient self-report.
There were 102 recurrent ICH events among 505 survivors of lobar ICH and 44 recurrent ICH events among 640 survivors of non-lobar ICH. During follow-up, adequate BP control (based on American Heart Association/American Stroke Association recommendations) was achieved on at least 1 measurement by 625 patients (55% of total) and consistently (at all available time points) by 495 patients (43% of total).
The researchers found that the ICH event rate for lobar and non-lobar ICH was higher among patients with inadequate BP control compared with patients with adequate BP control. Analyses indicated that inadequate BP control was associated with higher risk of recurrence of both lobar and non-lobar ICH. The association between elevated BP and ICH recurrence appeared to become stronger with worsening severity of hypertension.
Systolic BP during follow-up was associated with increased risk of both lobar and non-lobar ICH recurrence. Diastolic BP was associated with increased risk of non-lobar ICH recurrence, but not with lobar ICH recurrence.
“These results confirm that ICH survivors are at high risk for recurrence and support the hypothesis that aggressive blood pressure control may reduce this risk substantially,” the authors wrote.
They added that randomised clinical trials are needed to address the benefits and risks of stricter BP control in ICH survivors.