Kyle B Walsh1, Daniel Woo2, Padmini Sekar2, Jennifer Osborne2, Charles J Moomaw2, Carl D Langefeld2, Opeolu Adeoye2. 1. From Department of Emergency Medicine, University of Cincinnati, OH (K.B.W., O.A.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (D.W., P.S., J.O., C.J.M.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (C.D.L.); and University of Cincinnati Neuroscience Institute, OH (K.B.W., O.A., D.W.). walshk4@ucmail.uc.edu. 2. From Department of Emergency Medicine, University of Cincinnati, OH (K.B.W., O.A.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (D.W., P.S., J.O., C.J.M.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC (C.D.L.); and University of Cincinnati Neuroscience Institute, OH (K.B.W., O.A., D.W.).
Abstract
BACKGROUND: Hypertension is a significant risk factor for intracerebral hemorrhage (ICH). Although ethnic/racial disparities related to hypertension and ICH have been reported, these previous studies were limited by a lack of Hispanics and inadequate power to analyze by ICH location. In the current study, while overcoming these prior limitations, we investigated whether there was variation by ethnicity/race of treated and untreated hypertension as risk factors for ICH. METHODS: The ERICH study (Ethnic/Racial Variations of Intracerebral Hemorrhage) is a prospective, multicenter, case-control study of ICH among whites, blacks, and Hispanics. Cases were enrolled from 42 recruitment sites. Controls matched to cases 1:1 by age (±5 years), sex, ethnicity/race, and metropolitan area were identified by random-digit dialing. Subjects were interviewed to determine history of hypertension and use of antihypertensive medications. Cases and controls within ethnic groups were compared by using conditional logistic regression. Multivariable conditional logistic regression models were computed for ICH as an overall group and separately for the location subcategories deep, lobar, and infratentorial (brainstem/cerebellar). RESULTS:Nine hundred fifty-eight white, 880 black, and 766 Hispanic ICH patients were enrolled. For ICH cases, untreated hypertension was higher in blacks (43.6%, P<0.0001) and Hispanics (46.9%, P<0.0001) versus whites (32.7%). In multivariable analyses adjusted for alcohol use, anticoagulation, hypercholesterolemia, education, and medical insurance status, treated hypertension was a significant risk factor across all locations of ICH in whites (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.24-1.98; P<0.0001), blacks (OR, 3.02; 95% CI, 2.16-4.22; P<0.0001), and Hispanics (OR, 2.50; 95% CI, 1.73-3.62; P<0.0001). Untreated hypertension was a substantially greater risk factor for all 3 racial/ethnic groups across all locations of ICH: whites (OR, 8.79; 95% CI, 5.66-13.66; P<0.0001), blacks (OR, 12.46; 95% CI, 8.08-19.20; P<0.0001), and Hispanics (OR, 10.95; 95% CI, 6.58-18.23; P<0.0001). There was an interaction between race/ethnicity and ICH risk (P<0.0001). CONCLUSIONS:Untreated hypertension confers a greater ICH risk in blacks and Hispanics relative to whites across all anatomic locations of ICH. Accelerated research efforts are needed to improve overall hypertension treatment rates and to monitor the impact of such efforts on racial/ethnic disparities in stroke. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01202864.
RCT Entities:
BACKGROUND:Hypertension is a significant risk factor for intracerebral hemorrhage (ICH). Although ethnic/racial disparities related to hypertension and ICH have been reported, these previous studies were limited by a lack of Hispanics and inadequate power to analyze by ICH location. In the current study, while overcoming these prior limitations, we investigated whether there was variation by ethnicity/race of treated and untreated hypertension as risk factors for ICH. METHODS: The ERICH study (Ethnic/Racial Variations of Intracerebral Hemorrhage) is a prospective, multicenter, case-control study of ICH among whites, blacks, and Hispanics. Cases were enrolled from 42 recruitment sites. Controls matched to cases 1:1 by age (±5 years), sex, ethnicity/race, and metropolitan area were identified by random-digit dialing. Subjects were interviewed to determine history of hypertension and use of antihypertensive medications. Cases and controls within ethnic groups were compared by using conditional logistic regression. Multivariable conditional logistic regression models were computed for ICH as an overall group and separately for the location subcategories deep, lobar, and infratentorial (brainstem/cerebellar). RESULTS: Nine hundred fifty-eight white, 880 black, and 766 Hispanic ICHpatients were enrolled. For ICH cases, untreated hypertension was higher in blacks (43.6%, P<0.0001) and Hispanics (46.9%, P<0.0001) versus whites (32.7%). In multivariable analyses adjusted for alcohol use, anticoagulation, hypercholesterolemia, education, and medical insurance status, treated hypertension was a significant risk factor across all locations of ICH in whites (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.24-1.98; P<0.0001), blacks (OR, 3.02; 95% CI, 2.16-4.22; P<0.0001), and Hispanics (OR, 2.50; 95% CI, 1.73-3.62; P<0.0001). Untreated hypertension was a substantially greater risk factor for all 3 racial/ethnic groups across all locations of ICH: whites (OR, 8.79; 95% CI, 5.66-13.66; P<0.0001), blacks (OR, 12.46; 95% CI, 8.08-19.20; P<0.0001), and Hispanics (OR, 10.95; 95% CI, 6.58-18.23; P<0.0001). There was an interaction between race/ethnicity and ICH risk (P<0.0001). CONCLUSIONS: Untreated hypertension confers a greater ICH risk in blacks and Hispanics relative to whites across all anatomic locations of ICH. Accelerated research efforts are needed to improve overall hypertension treatment rates and to monitor the impact of such efforts on racial/ethnic disparities in stroke. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01202864.
Authors: William C Cushman; Charles E Ford; Jeffrey A Cutler; Karen L Margolis; Barry R Davis; Richard H Grimm; Henry R Black; Bruce P Hamilton; Joanne Holland; Chuke Nwachuku; Vasilios Papademetriou; Jeffery Probstfield; Jackson T Wright; Michael H Alderman; Robert J Weiss; Linda Piller; Judy Bettencourt; Sandra M Walsh Journal: J Clin Hypertens (Greenwich) Date: 2002 Nov-Dec Impact factor: 3.738
Authors: George Howard; Ron Prineas; Claudia Moy; Mary Cushman; Martha Kellum; Ella Temple; Andra Graham; Virginia Howard Journal: Stroke Date: 2006-03-23 Impact factor: 7.914
Authors: Daniel Woo; Laura R Sauerbeck; Brett M Kissela; Jane C Khoury; Jerzy P Szaflarski; James Gebel; Rakesh Shukla; Arthur M Pancioli; Edward C Jauch; Anil G Menon; Ranjan Deka; Janice A Carrozzella; Charles J Moomaw; Robert N Fontaine; Joseph P Broderick Journal: Stroke Date: 2002-05 Impact factor: 7.914
Authors: George Howard; Maciej Banach; Mary Cushman; David C Goff; Virginia J Howard; Daniel T Lackland; Jim McVay; James F Meschia; Paul Muntner; Suzanne Oparil; Melanie Rightmyer; Herman A Taylor Journal: Stroke Date: 2015-05-07 Impact factor: 7.914
Authors: Jared D Sturgeon; Aaron R Folsom; W T Longstreth; Eyal Shahar; Wayne D Rosamond; Mary Cushman Journal: Stroke Date: 2007-08-30 Impact factor: 7.914
Authors: George Howard; Daniel T Lackland; Dawn O Kleindorfer; Brett M Kissela; Claudia S Moy; Suzanne E Judd; Monika M Safford; Mary Cushman; Stephen P Glasser; Virginia J Howard Journal: JAMA Intern Med Date: 2013-01-14 Impact factor: 21.873
Authors: David A Calhoun; Daniel Jones; Stephen Textor; David C Goff; Timothy P Murphy; Robert D Toto; Anthony White; William C Cushman; William White; Domenic Sica; Keith Ferdinand; Thomas D Giles; Bonita Falkner; Robert M Carey Journal: Circulation Date: 2008-06-24 Impact factor: 29.690
Authors: Russell P Sawyer; Padmini Sekar; Jennifer Osborne; Steven J Kittner; Charles J Moomaw; Matthew L Flaherty; Carl D Langefeld; Christopher D Anderson; Jonathan Rosand; Daniel Woo Journal: Neurology Date: 2018-06-29 Impact factor: 9.910
Authors: Viren D Patel; Roxanna M Garcia; Dionne E Swor; Eric M Liotta; Matthew B Maas; Andrew Naidech Journal: J Stroke Cerebrovasc Dis Date: 2020-05-15 Impact factor: 2.136
Authors: Medha Barbhaiya; Candace H Feldman; Hongshu Guan; Sarah K Chen; Michael A Fischer; Daniel H Solomon; Brendan M Everett; Karen H Costenbader Journal: Semin Arthritis Rheum Date: 2018-07-31 Impact factor: 5.532