Abstract 179: Racial-ethnic Blood Pressure Differences in Acute Intracerebral Hemorrhage.

Background: Intracerebral hemorrhage (ICH) incidence and hypertension prevalence vary among racial-ethnic groups. Elevated blood pressure (BP) is common following ICH, but there are few racial/ethnic comparisons of acute BP. This study assessed the BP response to acute ICH in a multi-ethnic population. Methods: We examined BP in the field (EMS), emergency department (ED) and at 24 hours after ICH in subjects enrolled in the Ethnic Racial Variations of Intracerebral Hemorrhage (ERICH) study. ERICH is a multi-center prospective case-control study of ICH in non-Hispanic whites (whites), non-Hispanic blacks (blacks) and Hispanics. Baseline characteristics and BP recordings by EMS, in the ED and at 24 hours were analyzed for group differences. Results: Of 1052 subjects enrolled, BP recordings were available by EMS in 370, ED in 1041 and at 24 hours in 1014 cases of which 24% were white, 42% black and 34% Hispanic. Whites were significantly older 68± 14 years than blacks (58±13 years) and Hispanics (59± 15 years) (p≤0.0001) and had more lobar hemorrhages (39% vs. 23% blacks and 26% Hispanics; p≤0.0001). Baseline differences included larger hematoma volumes, in whites, and more frequent hypertension history and substance use, including cocaine use and smoking, in blacks. Blacks and Hispanics had significantly higher EMS (p=0.0001) and ED (p=0.0001) systolic BPs compared to whites (blacks: 198± 39, 195± 37; Hispanics: 191± 41, 191± 39; whites: 173± 37, 176± 37 mmHg). At 24 hours blacks had a higher systolic BP (144± 25 mmHg; p=0.0014) than Hispanics and whites (139± 21 and 138± 22 mmHg). These differences remained significant after adjustment for baseline group differences, including lobar and deep location. In multivariate analysis, low GCS and being black were associated with a systolic BP> 140mmHg at 24h. Blacks were more likely to receive BP treatment in the ER when compared to whites and Hispanics (76% vs. 52% and 68%). Conclusion: We found significant differences in the acute BP response to ICH, with blacks and Hispanics having a higher systolic BP at acute presentation. At 24 hours systolic BP remained elevated in blacks. These findings contribute to our understanding of racial-ethnic differences in BP and identify groups at risk for continued BP elevation.

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Abstract 49: Withdrawal of Care in the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) Study

Stroke ◽

10.1161/str.44.suppl_1.a49 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Kevin N Sheth ◽

Sharyl R Martini ◽

David L Tirschwell ◽

Kyra J Becker ◽

Bradford B Worrall ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Ethnic Groups ◽

Minority Groups ◽

Do Not Resuscitate ◽

Racial Variations ◽

Baseline Characteristics ◽

Race Ethnicity ◽

Gcs Score ◽

Racial Ethnic ◽

Hispanic White

Introduction: Withdrawal of care (WOC) during hospitalization is the most common cause of death after intracerebral hemorrhage (ICH). Prior work suggests minority groups are less likely to choose WOC. Our goal was to evaluate for differences in rates of WOC among racial/ethnic groups from the ERICH cohort. Methods: ERICH is an ongoing multicenter study of genetic and environmental risk factors for spontaneous ICH. We analyzed data from the first 725 individuals. Baseline characteristics,do not resuscitate (DNR) status, intensive care procedures, and WOC were prospectively recorded. A central core analyzed all imaging. We compared characteristics among patients with and without eventual WOC and by race/ethnicity. Logistic regression was used to identify variables independently associated with WOC and associations are presented as the odds ratio (95% confidence interval). Results: 9.9% (72/725) of patients underwent WOC. After controlling for age, ICH volume, initial Glasgow Coma Scale (GCS) score, and presence of intraventricular hemorrhage (IVH), there were no significant differences in WOC between non-Hispanic white, non-Hispanic black (OR 1.82; CI 0.78-4.25), and Hispanic (OR 2.16; CI 0.93-5.00) patients. There were also no differences in rates of DNR/DNI status across racial/ethnic groups. In multivariate analysis, patients who underwent WOC had larger ICH volume (1.75; 1.13-2.73); were older (1.43; 1.27-1.61), more likely to have IVH (3.21; 1.53-6.73), and had lower GCS (2.41; 1.63-3.56). While patients who underwent WOC were more likely to have a DNR/DNI order (12.7; 4.69-34.7), intubated patients were more likely to undergo WOC (4.09; 1.08-9.25), even after adjusting for ICH severity. Conclusions: In our cohort, we were able to model ICH severity and factors predictive of WOC. There were not significant racial/ethnic differences in WOC rates. Intubated patients are more likely to undergo care limitations, independent of ICH severity.

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Faculty Opinions recommendation of Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718013988.793489110 ◽

2014 ◽

Author(s):

Juan Sahuquillo ◽

Pedro Enríquez

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Blood Pressure Lowering ◽

Pressure Lowering ◽

Acute Intracerebral Hemorrhage

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Faculty Opinions recommendation of Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718013988.793480580 ◽

2013 ◽

Author(s):

Andrea Semplicini

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Blood Pressure Lowering ◽

Pressure Lowering ◽

Acute Intracerebral Hemorrhage

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Faculty Opinions recommendation of Rapid blood pressure reduction in acute intracerebral hemorrhage: feasibility and safety.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.721970192.793538775 ◽

2017 ◽

Author(s):

Lauren Sansing

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Blood Pressure Reduction ◽

Pressure Reduction ◽

Acute Intracerebral Hemorrhage

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Lower Treatment Blood Pressure Is Associated With Greatest Reduction in Hematoma Growth After Acute Intracerebral Hemorrhage

Hypertension ◽

10.1161/hypertensionaha.110.154328 ◽

2010 ◽

Vol 56 (5) ◽

pp. 852-858 ◽

Cited By ~ 52

Author(s):

Hisatomi Arima ◽

Craig S. Anderson ◽

Ji Guang Wang ◽

Yining Huang ◽

Emma Heeley ◽

...

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Lower Treatment ◽

Hematoma Growth ◽

Acute Intracerebral Hemorrhage

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USE OF NON-DRUG METHODS IN THE TREATMENT OF PATIENTS WITH ARTERIAL HYPERTENSION

Acta medica Eurasica ◽

10.47026/2413-4864-2021-3-10-17 ◽

2021 ◽

pp. 10-17

Author(s):

Olga D. Lebedeva ◽

Abduahat A. Achilov

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Clinical Effectiveness ◽

Cellular Tissue ◽

Active Treatment Group ◽

Comprehensive Treatment ◽

Therapeutic Exercises ◽

Baseline Group ◽

To Receive ◽

Selection Of

The aim of the study is to optimize the comprehensive treatment of patients with severe arterial hypertension, through the use of multicomponent rational antihypertensive pharmacotherapy, followed by the use of unloading therapeutic exercises. 32 men with severe arterial hypertension were examined. Initially, a clinical, instrumental and laboratory examination, registration of blood pressure and its 24-hour monitoring were carried out. The average daily systolic (ADBPsyst.) and average daily diastolic (ADBPdiast.) blood pressure were determined. A multicomponent rational antihypertensive pharmacotherapy, according to the clinical recommendations for the treatment of arterial hypertension was selected for all the patients. In at least 3 months after the selection of pharmacotherapy, the patients were divided into two groups, comparable in gender, age, severity of the condition, features of the disease course and medicamentous therapy. Patients of the 1st group (active treatment group) against the background of pharmacotherapy were prescribed unloading therapeutic exercises according to a patented technique. The 2nd group of patients continued to take pharmacotherapy and it was used as a baseline group. The average age in the 1st and 2nd groups was 46,3±6,8 and 43,6±7,2 years, respectively. Patients of the 1st group were prescribed unloading therapeutic exercises and in 3 months in both groups the ADBPsyst. and ADBPdiast. were compared. Initially, there was a significant increase in ADBPsyst. and ADBPdiast. compared to the normal range in both groups. These indicators in both groups differed insignificantly. In 3 months after pharmacotherapy, there was a significant decrease in ADsyst. and ADdiast. in both groups, but these indicators remained elevated and did not reach the target level. Then, in the 1st group, unloading therapeutic exercises were included in the comprehensive treatment. Patients of the 2nd group continued to receive pharmacotherapy. In 3 months after including unloading therapeutic exercises in the 1st group, there was a significant decrease in ADBP (syst. and diast.) not only in comparison with the initial data, but also with the data in 3 months after pharmacotherapy. In the 2nd group, these indicators did not change significantly compared to the three-month data. In 6 months, ADBPsyst. and ADBPdiast. in the 1st group were significantly lower compared to similar indicators in the 2nd group, which proves significant clinical effectiveness of unloading therapeutic exercises in patients of the 1st group. The results obtained confirm that patients with severe arterial hypertension have such types of disorders at the cellular-tissue and microcirculatory level that are not eliminated only by drug therapy. For their high-grade correction, along with multicomponent pharmacotherapy, it is necessary to include unloading therapeutic exercises. To optimize the treatment of severe arterial hypertension against the background of receiving multicomponent antihypertensive pharmacotherapy, it is recommended to include unloading therapeutic exercises in the therapeutic complex.

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Abstract TP188: Location of Intracerebral Hemorrhage in a Tri-ethnic Cohort: The ERICH Study

Stroke ◽

10.1161/str.44.suppl_1.atp188 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Lee Birnbaum ◽

Anne Leonard ◽

Julio Andino ◽

Charles J Moomaw ◽

Carl Langfeld ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Univariate Analysis ◽

Case Fatality ◽

Final Model ◽

Location Data ◽

History Of ◽

Race Ethnicity ◽

Pairwise Testing ◽

Racial Ethnic ◽

Control Study

Background: The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) is an ongoing case-control study of spontaneous ICH among non-hispanic whites, non-hispanic blacks, and Hispanics. Prior studies have identified hypertension as a greater risk for non-lobar (NL) ICH as compared with lobar (L) ICH. Given the greater reported prevalence of hypertension among black and Hispanic populations, we hypothesized that the location of ICH may differ by race/ethnicity. Methods: At the time of this analysis, we had ICH location data, lobar vs. non-lobar, on 648 subjects. We performed univariate analysis on known and potential predictors of ICH location: age, sex, race/ethnicity, hypertension, diabetes, BMI, creatinine, cholesterol, aspirin use, smoking, alcohol use, caffeine use, and INR. INR was dichotomized at >1.1. After forcing in age, sex, race, history of diabetes, aspirin use and INR, we added significant and near-significant (p<0.2) variables in a stepwise fashion to complete our final logistic regression model. Our outcome measure was lobar ICH. Conditional pairwise testing was performed for race/ethnicity. Results: Of the 648 subjects (mean age 61.12 ± 14.51 years; 39.8% female; 35.0% Hispanic, 26.5% white, 38.4% black), 181 (27.9%) presented with lobar ICH. Hypertension was present in 525 subjects (75.1% L, 83.3% NL; p=.018), diabetes in 152 (26.0% L, 22.5% NL; p=.348), high cholesterol in 244 (45.9% L, 34.5% NL; p=.008), aspirin use in 200 (37.0% L, 28.5% NL; p=.035), and INR >1.1 (24.1% L, 21.8% NL; p=.535) In our final model, race/ethnicity (p<.024) was associated with location of ICH. Furthermore, white race/ethnicity was associated with L ICH, compared with black (b=.57, p=.016) or Hispanic (b=.56, p=.018). Hypertension (b=-0.63, p=.009) was associated with NL ICH, and smoking (b=0.51, p=.007) was associated with L ICH. Discussion: Our results suggest that there are significant racial/ethnic differences in the distribution of lobar and non-lobar ICH. The conditional pairwise testing for race/ethnicity showed a significantly higher rate of lobar ICH in whites, compared with blacks or Hispanics. These findings are intriguing given the differences in case-fatality rates and age at ICH onset.

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Statistical analysis plan for pooled individual patient data from two landmark randomized trials (INTERACT2 and ATACH-II) of intensive blood pressure lowering treatment in acute intracerebral hemorrhage

International Journal of Stroke ◽

10.1177/1747493018813695 ◽

2018 ◽

Vol 14 (3) ◽

pp. 321-328 ◽

Cited By ~ 1

Author(s):

Tom J Moullaali ◽

Xia Wang ◽

Renee' H Martin ◽

Virginia B Shipes ◽

Adnan I Qureshi ◽

...

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Systolic Blood Pressure ◽

Functional Recovery ◽

Modified Rankin Scale ◽

Blood Pressure Lowering ◽

Safety Outcomes ◽

Pressure Lowering ◽

Acute Intracerebral Hemorrhage ◽

Intensive Blood Pressure

Background There is persistent uncertainty over the benefits of early intensive systolic blood pressure lowering in acute intracerebral hemorrhage. In particular, over the timing, target, and intensity of systolic blood pressure control for optimum balance of potential benefits (i.e. functional recovery) and risks (e.g. cerebral ischemia). Aims To determine associations of early systolic blood pressure lowering parameters and outcomes in patients with a hypertensive response in acute intracerebral hemorrhage. Secondary aims are to identify the modifying effects of patient characteristics and an optimal systolic blood pressure lowering profile. Methods Individual participant data pooled analyses of two large, multicenter, randomized controlled trials specifically undertaken to assess the effects of early intensive systolic blood pressure reduction on clinical outcomes in acute intracerebral hemorrhage: the Intensive Blood Pressure in Acute Intracerebral Hemorrhage Trial (INTERACT2) and the Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH-II) trial. Combined data will include baseline characteristics; systolic blood pressure in the first 24 h; process of care measures; and key efficacy and safety outcomes. Outcomes The primary outcome is functional recovery, defined by an ordinal distribution of scores on the modified Rankin scale at 90 days post-randomization. Secondary outcomes include various standard binary cut-points for disability-free survival on the modified Rankin scale, and health-related quality of life at 90 days. Safety outcomes include symptomatic hypotension requiring corrective therapy and early neurologic deterioration within 24 h, and deaths, any serious adverse event, and cardiac and renal serious adverse events, within 90 days. Discussion A pre-determined protocol was developed to facilitate successful collaboration and reduce analysis bias arising from prior knowledge of the findings. Clinical trial registration URL: http://www.clinicaltrials.gov . Unique identifiers for INTERACT2 (NCT00716079) and ATACH-II (NCT01176565).

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