Poor long-term blood pressure control after intracerebral hemorrhage.
OBJECTIVE
Hypertension is the most important risk factor associated with intracerebral hemorrhage. We explored racial differences in blood pressure (BP) control after intracerebral hemorrhage and assessed predictors of BP control at presentation, 30 days, and 1 year in a prospective cohort study.


METHODS
Subjects with spontaneous intracerebral hemorrhage were identified from the DiffErenCes in the Imaging of Primary Hemorrhage based on Ethnicity or Race (DECIPHER) Project. BP was compared by race at each time point. Multivariable linear regression was used to determine predictors of presenting mean arterial pressure, and longitudinal linear regression was used to assess predictors of mean arterial pressure at follow-up.


RESULTS
A total of 162 patients were included (mean age, 59 years; 53% male; 77% black). Mean arterial pressure at presentation was 9.6 mm Hg higher in blacks than whites despite adjustment for confounders (P=0.065). Fewer than 20% of patients had normal BP (<120/80 mm Hg) at 30 days or 1 year. Although there was no difference at 30 days (P=0.331), blacks were more likely than whites to have Stage I/II hypertension at 1 year (P=0.036). Factors associated with lower mean arterial pressure at follow-up in multivariable analysis were being married at baseline (P=0.032) and living in a facility (versus personal residence) at the time of BP measurement (P=0.023).


CONCLUSIONS
Long-term BP control is inadequate in patients after intracerebral hemorrhage, particularly in blacks. Further studies are needed to understand the role of social support and barriers to control to identify optimal approaches to improve BP in this high-risk population.
Department of Neurology, Stroke Program, School of Public Health, University of Michigan Cardiovascular Center, Ann Arbor, MI 48109-5855, USA. zdarin@umich.edu
Darin B
DB
Zahuranec
Jeffrey J
JJ
Wing
Dorothy F
DF
Edwards
Ravi S
RS
Menon
Stephen J
SJ
Fernandez
Richard E
RE
Burgess
Ian A
IA
Sobotka
Laura
L
German
Anna J
AJ
Trouth
Nawar M
NM
Shara
M Chris
MC
Gibbons
Bernadette
B
Boden-Albala
Chelsea S
CS
Kidwell
D000959:Antihypertensive Agents / Q000627:therapeutic use; D044383:Black People / Q000208:ethnology*; D001794:Blood Pressure / Q000502:physiology*; D002543:Cerebral Hemorrhage / Q000208:ethnology* / Q000503:physiopathology*; D015331:Cohort Studies; D004777:Environment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000208:ethnology* / Q000503:physiopathology / Q000517:prevention & control*; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012944:Social Support; D013997:Time Factors; D016896:Treatment Outcome; D044465:White People / Q000208:ethnology*
D000959:Antihypertensive Agents