Sebastian Koch1, Mitchell S V Elkind2, Fernando D Testai2, W Mark Brown2, Sharyl Martini2, Kevin N Sheth2, Ji Y Chong2, Jennifer Osborne2, Charles J Moomaw2, Carl D Langefeld2, Ralph L Sacco2, Daniel Woo2. 1. From the Miller School of Medicine (S.K., R.L.S.), University of Miami, FL; Columbia University (M.S.V.E.), New York, NY; University of Illinois (F.D.T.), Chicago; Wake Forest School of Medicine (W.M.B., C.D.L.), Winston-Salem, NC; Michael E. DeBakey VA Medical Center and Baylor College of Medicine (S.M.), Houston, TX; Yale University (K.N.S.), New haven, CT; Cornell University (J.Y.C.), Ithaca, NY; and University of Cincinnati (J.O., C.J.M., D.W.), OH. skoch@med.miami.edu. 2. From the Miller School of Medicine (S.K., R.L.S.), University of Miami, FL; Columbia University (M.S.V.E.), New York, NY; University of Illinois (F.D.T.), Chicago; Wake Forest School of Medicine (W.M.B., C.D.L.), Winston-Salem, NC; Michael E. DeBakey VA Medical Center and Baylor College of Medicine (S.M.), Houston, TX; Yale University (K.N.S.), New haven, CT; Cornell University (J.Y.C.), Ithaca, NY; and University of Cincinnati (J.O., C.J.M., D.W.), OH.
Abstract
OBJECTIVE: To assess race-ethnic differences in acute blood pressure (BP) following intracerebral hemorrhage (ICH) and the contribution to disparities in ICH outcome. METHODS: BPs in the field (emergency medical services [EMS]), emergency department (ED), and at 24 hours were compared and adjusted for group differences between non-Hispanic black (black), non-Hispanic white (white), and Hispanic participants in the Ethnic Racial Variations of Intracerebral Hemorrhage case-control study. Outcome was obtained by modified Rankin Scale (mRS) score at 3 months. We analyzed race-ethnic differences in good outcome (mRS ≤ 2) and mortality after adjusting for baseline differences and included BP recordings in this model. RESULTS: Of 2,069 ICH cases enrolled, 30% were white, 37% black, and 33% Hispanic. Black and Hispanic patients had higher EMS and ED systolic and diastolic BPs compared with white patients (p = 0.0001). Although attenuated, at 24 hours after admission, black patients had higher systolic and diastolic BPs. After adjusting for baseline differences, significant race/ethnic differences persisted for EMS systolic, ED systolic and diastolic, and 24-hours diastolic BP. Only ED systolic and diastolic BP was associated with poor functional outcome, and no BP predicted mortality. We found no race-ethnic differences in 3-month functional outcome or mortality after adjusting for group differences, including acute BPs. CONCLUSIONS: Although black and Hispanic patients had higher BPs than white patients at presentation, we did not find race-ethnic disparities in 3-month functional outcome or mortality. ED systolic and diastolic BP was associated with poor functional outcome, but not mortality, in this race-ethnically diverse population.
OBJECTIVE: To assess race-ethnic differences in acute blood pressure (BP) following intracerebral hemorrhage (ICH) and the contribution to disparities in ICH outcome. METHODS: BPs in the field (emergency medical services [EMS]), emergency department (ED), and at 24 hours were compared and adjusted for group differences between non-Hispanic black (black), non-Hispanic white (white), and Hispanic participants in the Ethnic Racial Variations of Intracerebral Hemorrhage case-control study. Outcome was obtained by modified Rankin Scale (mRS) score at 3 months. We analyzed race-ethnic differences in good outcome (mRS ≤ 2) and mortality after adjusting for baseline differences and included BP recordings in this model. RESULTS: Of 2,069 ICH cases enrolled, 30% were white, 37% black, and 33% Hispanic. Black and Hispanic patients had higher EMS and ED systolic and diastolic BPs compared with white patients (p = 0.0001). Although attenuated, at 24 hours after admission, black patients had higher systolic and diastolic BPs. After adjusting for baseline differences, significant race/ethnic differences persisted for EMS systolic, ED systolic and diastolic, and 24-hours diastolic BP. Only ED systolic and diastolic BP was associated with poor functional outcome, and no BP predicted mortality. We found no race-ethnic differences in 3-month functional outcome or mortality after adjusting for group differences, including acute BPs. CONCLUSIONS: Although black and Hispanic patients had higher BPs than white patients at presentation, we did not find race-ethnic disparities in 3-month functional outcome or mortality. ED systolic and diastolic BP was associated with poor functional outcome, but not mortality, in this race-ethnically diverse population.
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