Bibliographic Details
| Title: |
Abstract P878: Racial and Ethnic Disparities in Early Hypertension Control After Intracerebral Hemorrhage |
| Authors: |
Castello, Juan Pablo, Teo, Kay Cheong, Abramson, Jessica R, Leung, Ian Y, Leung, William Chun-yin, Wang, Yujie, Kourkoulis, Christina, Myserlis, Evangelos Pavlos, Warren, Andrew, Henry, Jonathan, Chan, Koon Ho H, Cheung, Raymond, Ho, Shu Leong, Anderson, Christopher D, Gurol, Edip M, Viswanathan, Anand, Greenberg, Steven M, Lau, Kui Kai, Rosand, Jonathan, Biffi, Alessandro |
| Source: |
Stroke (Ovid); March 2021, Vol. 52 Issue: Supplement 1 pAP878-AP878, 1p |
| Abstract: |
Introduction:Survivors of Intracerebral Hemorrhage (ICH) are at high risk of recurrent stroke. This risk is inversely proportional to average Blood Pressure (BP) after ICH. Racial/ethnic minority ICH survivors in the US demonstrate greater hypertension severity after ICH and are at higher risk of recurrent cerebral bleeding. Since most recurrent strokes occur within 12-18 months of index ICH, rapidly achieving BP control is likely to be crucial. We investigated the frequency, prognostic impact, and racial/ethnic disparities in uncontrolled short-term hypertension (HTN) after ICH.Methods:We analyzed data from prospective ICH cohort studies at Massachusetts General Hospital (MGH-ICH, n=1305) and the University of Hong Kong (HK-ICH, n=523). We classified HTN as controlled, uncontrolled or treatment-resistant and determined: 1) risk factors for uncontrolled and treatment-resistant HTN; and 2) whether HTN control at 3 months is associated with long-term BP control, stroke recurrence and mortality across self-reported race/ethnicity groups.Results:We followed 1828 ICH survivors (1128 White, 565 Asian, 59 Hispanic, 49 Black, 27 other) for a median of 46.2 months. Only 9 of 172 (5%) recurrent strokes occurred before 3 months after ICH. At 3 months, 713 participants (39%) had controlled HTN, 755 (41%) had undertreated HTN, and 360 (20%) had treatment-resistant HTN. BP measurements at 3 months were highly correlated with measurements during follow-up (p<0.001). Black, Hispanic and Asian race/ethnicity were associated with higher prevalence of uncontrolled HTN at 3 months (all p<0.05). Both undertreated and uncontrolled HTN at 3 months were associated with increased risk of recurrent stroke and mortality during follow-up (all p<0.05).Conclusions:Most ICH survivors have inadequate HTN control 3 months after ICH, with under-treatment accounting for the majority of cases. Three-month BP measurements are associated with inadequate long-term HTN control, higher recurrent stroke risk and mortality. ICH survivors self-reporting as Black, Hispanic or Asian appear to be at highest risk for uncontrolled HTN. Optimizing HTN control at 3 months is a unique opportunity to address racial/ethnic disparities in quality of care among survivors of primary ICH. |
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