TY - JOUR
T1 - Biological and Social Determinants of Hypertension Severity before vs after Intracerebral Hemorrhage
AU - Abramson, Jessica R.
AU - Castello, Juan Pablo
AU - Keins, Sophia
AU - Kourkoulis, Christina
AU - Rodriguez-Torres, Axana
AU - Myserlis, Evangelos Pavlos
AU - Alabsi, Haitham
AU - Warren, Andrew D.
AU - Henry, Jonathan Q.A.
AU - Gurol, M. Edip
AU - Viswanathan, Anand
AU - Greenberg, Steven M.
AU - Towfighi, Amytis
AU - Skolarus, Lesli
AU - Anderson, Christopher D.
AU - Rosand, Jonathan
AU - Biffi, Alessandro
N1 - Funding Information:
S.M. Greenberg is supported by NIH R01AG26484. C.D. Anderson is supported by NIH R01NS103924, U01NS069763, and the AHA-Bugher Foundation, receives sponsored research support from Massachusetts General Hospital and Bayer AG, and reports consulting for ApoPharma and Invitae. L. Skolarus is supported by the AHA, NIH R01AG059733, U01MD010579, R01MD011516, and R21AG071796, and has consulted for Bracket Global. J. Rosand is supported by the AHA-Bugher Foundation, NIH R01NS036695, UM1HG008895, R01NS093870, and R24NS092983, and has consulted for Boehringer Ingelheim. A. Biffi is supported by Massachusetts General Hospital, the AHA-Bugher Foundation, and NIH K23NS100816. The remaining authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Publisher Copyright:
© American Academy of Neurology.
PY - 2022/3/29
Y1 - 2022/3/29
N2 - Background and ObjectivesAlthough blood pressure (BP) control is considered the most effective measure to prevent functional decline after intracerebral hemorrhage (ICH), fewer than half of survivors achieve treatment goals. We hypothesized that long-term (i.e., prehemorrhage) hypertension severity may be a crucial factor in explaining poor BP control after ICH. We investigated changes in hypertension severity after vs before ICH using latent class analysis (LCA) and identified patient characteristics predictive of individuals' BP trajectories.MethodsWe analyzed data for ICH survivors enrolled in a study conducted at Massachusetts General Hospital (MGH) from 2002 to 2019 in Boston, a high-resource setting with near-universal medical insurance coverage. We captured BP measurements in the 12 months preceding and following the acute ICH hospitalization. Using LCA, we identified patient groups (classes) based on changes in hypertension severity over time in an unbiased manner. We then created multinomial logistic regression models to identify patient factors associated with these classes.ResultsAmong 336 participants, the average age was 74.4 years, 166 (49%) were male, and 288 (86%) self-reported White race/ethnicity. LCA identified 3 patient classes, corresponding to minimal (n = 114, 34%), intermediate (n = 128, 38%), and substantial (n = 94, 28%) improvement in hypertension severity after vs before ICH. Survivors with undertreated (relative risk ratio [RRR] 0.05, 95% CI 0.01-0.23) or resistant (RRR 0.03, 95% CI 0.01-0.06) hypertension before ICH were less likely to experience substantial improvement afterwards. Residents of high-income neighborhoods were more likely to experience substantial improvement (RRR 1.14 per $10,000, 95% CI 1.02-1.28). Black, Hispanic, and Asian participants with uncontrolled hypertension before ICH were more likely to experience minimal improvement after hemorrhagic stroke (interaction p < 0.001).DiscussionMost ICH survivors do not display consistent improvement in hypertension severity after hemorrhagic stroke. BP control after ICH is profoundly influenced by patient characteristics predating the hemorrhage, chiefly prestroke hypertension severity and socioeconomic status. Neighborhood income was associated with hypertension severity after ICH in a high-resource setting with near-universal health care coverage. These findings likely contribute to previously documented racial/ethnic disparities in BP control and clinical outcomes following ICH.
AB - Background and ObjectivesAlthough blood pressure (BP) control is considered the most effective measure to prevent functional decline after intracerebral hemorrhage (ICH), fewer than half of survivors achieve treatment goals. We hypothesized that long-term (i.e., prehemorrhage) hypertension severity may be a crucial factor in explaining poor BP control after ICH. We investigated changes in hypertension severity after vs before ICH using latent class analysis (LCA) and identified patient characteristics predictive of individuals' BP trajectories.MethodsWe analyzed data for ICH survivors enrolled in a study conducted at Massachusetts General Hospital (MGH) from 2002 to 2019 in Boston, a high-resource setting with near-universal medical insurance coverage. We captured BP measurements in the 12 months preceding and following the acute ICH hospitalization. Using LCA, we identified patient groups (classes) based on changes in hypertension severity over time in an unbiased manner. We then created multinomial logistic regression models to identify patient factors associated with these classes.ResultsAmong 336 participants, the average age was 74.4 years, 166 (49%) were male, and 288 (86%) self-reported White race/ethnicity. LCA identified 3 patient classes, corresponding to minimal (n = 114, 34%), intermediate (n = 128, 38%), and substantial (n = 94, 28%) improvement in hypertension severity after vs before ICH. Survivors with undertreated (relative risk ratio [RRR] 0.05, 95% CI 0.01-0.23) or resistant (RRR 0.03, 95% CI 0.01-0.06) hypertension before ICH were less likely to experience substantial improvement afterwards. Residents of high-income neighborhoods were more likely to experience substantial improvement (RRR 1.14 per $10,000, 95% CI 1.02-1.28). Black, Hispanic, and Asian participants with uncontrolled hypertension before ICH were more likely to experience minimal improvement after hemorrhagic stroke (interaction p < 0.001).DiscussionMost ICH survivors do not display consistent improvement in hypertension severity after hemorrhagic stroke. BP control after ICH is profoundly influenced by patient characteristics predating the hemorrhage, chiefly prestroke hypertension severity and socioeconomic status. Neighborhood income was associated with hypertension severity after ICH in a high-resource setting with near-universal health care coverage. These findings likely contribute to previously documented racial/ethnic disparities in BP control and clinical outcomes following ICH.
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U2 - 10.1212/WNL.0000000000200003
DO - 10.1212/WNL.0000000000200003
M3 - Article
C2 - 35131909
AN - SCOPUS:85127639022
SN - 0028-3878
VL - 98
SP - E1349-E1360
JO - Neurology
JF - Neurology
IS - 13
ER -