Myserlis Evangelos Pavlos, Mayerhofer Ernst, Abramson Jessica R, Teo Kay-Cheong, Montgomery Bailey E, Sugita Lansing, Warren Andrew D, Goldstein Joshua N, Gurol Mahmut Edip, Viswanathan Anand, Greenberg Steven M, Biffi Alessandro, Anderson Christopher D, Rosand Jonathan
Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Eur Stroke J. 2022 Sep;7(3):280-288. doi: 10.1177/23969873221094412. Epub 2022 Apr 27.
Uncontrolled blood pressure (BP) in intracerebral hemorrhage (ICH) survivors is common and associated with adverse clinical outcomes. We investigated whether characteristics of the ICH itself were associated with uncontrolled BP at follow-up.
Subjects were consecutive patients aged ⩾18 years with primary ICH enrolled in the prospective longitudinal ICH study at Massachusetts General Hospital between 1994 and 2015. We assessed the prevalence of uncontrolled BP (mean BP ⩾140/90 mmHg) 6 months after index event. We used multivariable logistic regression models to assess the effect of hematoma location, volume, and event year on uncontrolled BP.
Among 1492 survivors, ICH was lobar in 624 (42%), deep in 749 (50%), cerebellar in 119 (8%). Lobar ICH location was associated with increased risk for uncontrolled BP after 6 months (OR 1.35; 95% CI [1.08-1.69]). On average, lobar ICH survivors were treated with fewer antihypertensive drugs compared to the rest of the cohort: 2.1 ± 1.1 vs 2.5 ± 1.2 ( < 0.001) at baseline and 1.8 ± 1.2 vs. 2.4 ± 1.2 ( < 0.001) after 6 months follow-up. After adjustment for the number of antihypertensive drugs prescribed, the association of lobar ICH location with risk of uncontrolled BP was eliminated.
ICH survivors with lobar hemorrhage were more likely to have uncontrolled BP after 6 months follow-up. This appears to be a result of being prescribed fewer antihypertensive medications. Future treatment strategies should focus on aggressive BP control after ICH independent of hemorrhage location.
脑出血（ICH）幸存者中血压（BP）控制不佳很常见，且与不良临床结局相关。我们调查了脑出血本身的特征是否与随访时血压控制不佳相关。
研究对象为1994年至2015年期间在马萨诸塞州总医院参加前瞻性纵向脑出血研究的年龄≥18岁的原发性脑出血连续患者。我们评估了索引事件发生6个月后血压控制不佳（平均血压≥140/90 mmHg）的患病率。我们使用多变量逻辑回归模型来评估血肿位置、体积和事件年份对血压控制不佳的影响。
在1492名幸存者中，624例（42%）为脑叶出血，749例（50%）为深部出血，119例（8%）为小脑出血。脑叶出血部位与6个月后血压控制不佳风险增加相关（比值比1.35；95%置信区间[1.08 - 1.69]）。平均而言，与队列中的其他患者相比，脑叶出血幸存者接受的降压药物较少：基线时为2.1±1.1 vs 2.5±1.2（P<0.001），6个月随访后为1.8±1.2 vs 2.4±1.2（P<0.001）。在调整所开降压药物数量后，脑叶出血部位与血压控制不佳风险的关联被消除。
脑叶出血的脑出血幸存者在6个月随访后更有可能血压控制不佳。这似乎是由于所开降压药物较少所致。未来的治疗策略应侧重于脑出血后积极控制血压，而不考虑出血部位。
