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J Stroke Cerebrovasc Dis. 2019 Mar;28(3):782-788. doi: 10.1016/j.jstrokecerebrovasdis.2018.11.023. Epub 2018 Dec 13.

How Does Preexisting Hypertension Affect Patients with Intracerebral Hemorrhage?

Author information

1
Department of Neurology, New York University School of Medicine, New York, New York. Electronic address: david.valentine2@nyumc.org.
2
Department of Neurology, New York University School of Medicine, New York, New York; Department of Neurosurgery, New York University School of Medicine, New York, New York.
3
Department of Neurology, New York University School of Medicine, New York, New York.
4
Department of Neurology, New York University School of Medicine, New York, New York; Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York; Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio.

Abstract

BACKGROUND AND PURPOSE:

Patients with intracerebral hemorrhage (ICH) frequently present with hypertension, but it is unclear if this is due to pre-existing hypertension (prHTN) or to the bleed itself or associated pain. We sought to assess the relationship between prHTN and admission systolic blood pressure (aBP) and bleed severity.

METHODS:

We retrospectively assessed the relationship between prHTN and aBP and NIHSS in patients with ICH at 3 institutions.

RESULTS:

Of 251 patients, 170 (68%) had prHTN based on history of hypertension/antihypertensive use. Median aBP was significantly higher in those with prHTN (155 mm Hg (IQR 135-181) versus 139 mm Hg (IQR 124-158), P < .001). Patients with left ventricular hypertrophy (LVH) on electrocardiogram (ECG) or transthoracic echocardiogram (TTE) had significantly higher aBP than those without LVH (median aBP 195 mm Hg (IQR 155-216) for patients with LVH on ECG versus 147 mm Hg (IQR 129-163) for patients with no LVH on ECG, P < .001; median aBP 181 mm Hg (IQR 153-214) for patients with LVH on TTE versus 152 mm Hg (IQR 137-169) for patients with no LVH on TTE, P = .01). prHTN was associated with a higher median NIHSS (11 (IQR 3-20) for patients with history of hypertension/antihypertensive use versus 6 (IQR 1-14) for patients without this history (P = .02); 9 (IQR 3-19) versus 5 (IQR 2-13) for patients with/without LVH on ECG (P = .085); and 10 (IQR 5-18) versus 5 (IQR 1-13) for patients with/without LVH on TTE (P = .046).

CONCLUSIONS:

Patients with ICH who have prHTN have higher aBP and NIHSS, suggesting that prHTN may worsen reactive hypertension in the setting of ICH.

KEYWORDS:

Intracerebral hemorrhage; hypertension

[Indexed for MEDLINE]

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