Mario Hevesi1, Eric M Bershad2, Mostafa Jafari1, Stephan A Mayer3, Magdy Selim4, Jose I Suarez5, Afshin A Divani6. 1. Department of Neurology, University of Minnesota, Minneapolis, MN, United States. 2. Division of Vascular Neurology and Neurocritical Care, Department of Neurology, Baylor College of Medicine, Houston, TX, United States. 3. Department of Neurology, Henry Ford Health System, Detroit, MI, United States. 4. Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States. 5. Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, Johns Hopkins University, Baltimore, MD, United States. 6. Department of Neurology, University of Minnesota, Minneapolis, MN, United States; Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States. Electronic address: divani@umn.edu.
Abstract
PURPOSE: Hypertension is a significant risk factor for intracerebral hemorrhage (ICH). The importance of managing blood pressure to reduce the risk of ICH has been recognized. However, few studies have focused on ICH outcomes due to untreated hypertension. MATERIALS AND METHODS: We conducted a 5-year, retrospective, multicenter study of 490 consecutive ICH patients with histories of untreated-hypertension (n=56), treated-hypertension (n=314), and normotension (n=120). Demographics, symptom onset, vital signs, laboratory tests, and CT imaging were documented alongside in-hospital treatments, complications, and length of stay. RESULTS: Untreated-hypertension subjects were found to be significantly younger than treated-hypertension. They were found to have lower rates of anticoagulant use (p<0.01), antiplatelet use (p<0.01), and hyperlipidemia (p<0.01) than subjects with treated-hypertension. In a multivariate model, untreated-hypertension, age ≥65years, ≥3 outpatient antihypertensive medications, and hematoma volumes ≥30ml were all associated with significantly increased in-hospital mortality. In contrast, mortality was lower in patients receiving ≥3 antihypertensive medications while in-hospital. CONCLUSIONS: Subjects with untreated-hypertension were younger and had fewer comorbidities when compared with treated-hypertension and were similar when compared to normotensive individuals. Once demographic and in-hospital factors were accounted for, untreated-hypertension subjects demonstrated significantly increased in-hospital mortality following ICH when compared with normotensive individuals.
PURPOSE:Hypertension is a significant risk factor for intracerebral hemorrhage (ICH). The importance of managing blood pressure to reduce the risk of ICH has been recognized. However, few studies have focused on ICH outcomes due to untreated hypertension. MATERIALS AND METHODS: We conducted a 5-year, retrospective, multicenter study of 490 consecutive ICHpatients with histories of untreated-hypertension (n=56), treated-hypertension (n=314), and normotension (n=120). Demographics, symptom onset, vital signs, laboratory tests, and CT imaging were documented alongside in-hospital treatments, complications, and length of stay. RESULTS: Untreated-hypertension subjects were found to be significantly younger than treated-hypertension. They were found to have lower rates of anticoagulant use (p<0.01), antiplatelet use (p<0.01), and hyperlipidemia (p<0.01) than subjects with treated-hypertension. In a multivariate model, untreated-hypertension, age ≥65years, ≥3 outpatient antihypertensive medications, and hematoma volumes ≥30ml were all associated with significantly increased in-hospital mortality. In contrast, mortality was lower in patients receiving ≥3 antihypertensive medications while in-hospital. CONCLUSIONS: Subjects with untreated-hypertension were younger and had fewer comorbidities when compared with treated-hypertension and were similar when compared to normotensive individuals. Once demographic and in-hospital factors were accounted for, untreated-hypertension subjects demonstrated significantly increased in-hospital mortality following ICH when compared with normotensive individuals.
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