Blood Pressure and Outcomes in Patients With Different Etiologies of Intracerebral Hemorrhage: A Multicenter Cohort Study
Background We aimed to investigate the association between blood pressure (BP) and outcomes in intracerebral hemorrhage (ICH) subtypes with different etiologies. Methods and Results A total of 5656 in‐hospital patients with spontaneous ICH were included between January 2012 and December 2016 in a pr...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.016766 |
| _version_ | 1819175099791572992 |
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| author | Shuting Zhang Zhihao Wang Aiping Zheng Ruozhen Yuan Yang Shu Shihong Zhang Peng Lei Bo Wu Ming Liu |
| author_facet | Shuting Zhang Zhihao Wang Aiping Zheng Ruozhen Yuan Yang Shu Shihong Zhang Peng Lei Bo Wu Ming Liu |
| author_sort | Shuting Zhang |
| collection | DOAJ |
| description | Background We aimed to investigate the association between blood pressure (BP) and outcomes in intracerebral hemorrhage (ICH) subtypes with different etiologies. Methods and Results A total of 5656 in‐hospital patients with spontaneous ICH were included between January 2012 and December 2016 in a prospective multicenter cohort study. Etiological subtypes of ICH were assigned using SMASH‐U (structural lesion, medication, amyloid angiopathy, systemic/other disease, hypertension, undetermined) classification. Elevated systolic BP was defined as ≥140 mm Hg. Hypertension was defined as elevated BP for >1 month before the onset of ICH. The primary outcomes were measured as 1‐month survival rate and 3‐month mortality. A total of 5380 patients with ICH were analyzed, of whom 4052 (75.3%) had elevated systolic BP on admission and 3015 (56.0%) had hypertension. In multinomial analysis of patients who passed away by 3 months, systolic BP on admission was significantly different in cerebral amyloid angiopathy (P<0.001), structural lesion (P<0.001), and undetermined subtypes (P=0.003), compared with the hypertensive angiopathy subtype. Elevated systolic BP was dose‐responsively associated with higher 3‐month mortality in hypertensive angiopathy (Ptrend=0.013) and undetermined (Ptrend=0.005) subtypes. In cerebral amyloid angiopathy, hypertension history had significant inverse association with 3‐month mortality (adjusted odds ratio, 0.37, 95% CI, 0.20–0.65; P<0.001). Similarly, adjusted Cox regression indicated decreased risk of 1‐month survival rate in the presence of hypertension in patients with cerebral amyloid angiopathy (adjusted hazard ratio, 0.47; 95% CI, 0.24–0.92; P=0.027). Conclusions This study suggests that the association between BP and ICH outcomes might specifically depend on its subtypes, and cerebral amyloid angiopathy might be pathologically distinctive from the others. Future studies of individualized BP‐lowering strategy are needed to validate our findings. |
| first_indexed | 2024-12-22T20:49:29Z |
| format | Article |
| id | doaj.art-90465addc3da47af96aa502ecf4436a2 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T20:49:29Z |
| publishDate | 2020-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-90465addc3da47af96aa502ecf4436a22022-12-21T18:13:08ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-10-0191910.1161/JAHA.120.016766Blood Pressure and Outcomes in Patients With Different Etiologies of Intracerebral Hemorrhage: A Multicenter Cohort StudyShuting Zhang0Zhihao Wang1Aiping Zheng2Ruozhen Yuan3Yang Shu4Shihong Zhang5Peng Lei6Bo Wu7Ming Liu8Department of Neurology West China Hospital of Sichuan University Chengdu Sichuan Province P.R. ChinaWest China School of Medicine Sichuan University Chengdu Sichuan Province P.R. ChinaWest China School of Medicine Sichuan University Chengdu Sichuan Province P.R. ChinaDepartment of Neurology West China Hospital of Sichuan University Chengdu Sichuan Province P.R. ChinaState Key Laboratory of Biotherapy West China Hospital of Sichuan University Chengdu Sichuan Province P.R. ChinaDepartment of Neurology West China Hospital of Sichuan University Chengdu Sichuan Province P.R. ChinaState Key Laboratory of Biotherapy West China Hospital of Sichuan University Chengdu Sichuan Province P.R. ChinaDepartment of Neurology West China Hospital of Sichuan University Chengdu Sichuan Province P.R. ChinaDepartment of Neurology West China Hospital of Sichuan University Chengdu Sichuan Province P.R. ChinaBackground We aimed to investigate the association between blood pressure (BP) and outcomes in intracerebral hemorrhage (ICH) subtypes with different etiologies. Methods and Results A total of 5656 in‐hospital patients with spontaneous ICH were included between January 2012 and December 2016 in a prospective multicenter cohort study. Etiological subtypes of ICH were assigned using SMASH‐U (structural lesion, medication, amyloid angiopathy, systemic/other disease, hypertension, undetermined) classification. Elevated systolic BP was defined as ≥140 mm Hg. Hypertension was defined as elevated BP for >1 month before the onset of ICH. The primary outcomes were measured as 1‐month survival rate and 3‐month mortality. A total of 5380 patients with ICH were analyzed, of whom 4052 (75.3%) had elevated systolic BP on admission and 3015 (56.0%) had hypertension. In multinomial analysis of patients who passed away by 3 months, systolic BP on admission was significantly different in cerebral amyloid angiopathy (P<0.001), structural lesion (P<0.001), and undetermined subtypes (P=0.003), compared with the hypertensive angiopathy subtype. Elevated systolic BP was dose‐responsively associated with higher 3‐month mortality in hypertensive angiopathy (Ptrend=0.013) and undetermined (Ptrend=0.005) subtypes. In cerebral amyloid angiopathy, hypertension history had significant inverse association with 3‐month mortality (adjusted odds ratio, 0.37, 95% CI, 0.20–0.65; P<0.001). Similarly, adjusted Cox regression indicated decreased risk of 1‐month survival rate in the presence of hypertension in patients with cerebral amyloid angiopathy (adjusted hazard ratio, 0.47; 95% CI, 0.24–0.92; P=0.027). Conclusions This study suggests that the association between BP and ICH outcomes might specifically depend on its subtypes, and cerebral amyloid angiopathy might be pathologically distinctive from the others. Future studies of individualized BP‐lowering strategy are needed to validate our findings.https://www.ahajournals.org/doi/10.1161/JAHA.120.0167661‐month survival rate3‐month deathblood pressureetiologiesintracerebral hemorrhage |
| spellingShingle | Shuting Zhang Zhihao Wang Aiping Zheng Ruozhen Yuan Yang Shu Shihong Zhang Peng Lei Bo Wu Ming Liu Blood Pressure and Outcomes in Patients With Different Etiologies of Intracerebral Hemorrhage: A Multicenter Cohort Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease 1‐month survival rate 3‐month death blood pressure etiologies intracerebral hemorrhage |
| title | Blood Pressure and Outcomes in Patients With Different Etiologies of Intracerebral Hemorrhage: A Multicenter Cohort Study |
| title_full | Blood Pressure and Outcomes in Patients With Different Etiologies of Intracerebral Hemorrhage: A Multicenter Cohort Study |
| title_fullStr | Blood Pressure and Outcomes in Patients With Different Etiologies of Intracerebral Hemorrhage: A Multicenter Cohort Study |
| title_full_unstemmed | Blood Pressure and Outcomes in Patients With Different Etiologies of Intracerebral Hemorrhage: A Multicenter Cohort Study |
| title_short | Blood Pressure and Outcomes in Patients With Different Etiologies of Intracerebral Hemorrhage: A Multicenter Cohort Study |
| title_sort | blood pressure and outcomes in patients with different etiologies of intracerebral hemorrhage a multicenter cohort study |
| topic | 1‐month survival rate 3‐month death blood pressure etiologies intracerebral hemorrhage |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.016766 |
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