Hypertension control after intracerebral hemorrhage among varying small vessel disease etiologies

Area of Science:

• Neurology
• Cardiovascular Science
• Radiology

Background:

• Intracerebral hemorrhage (ICH) is linked to cerebral small vessel disease (cSVD), encompassing cerebral amyloid angiopathy (CAA) and hypertensive-cSVD (HTN-cSVD).
• Hypertensive-cSVD presents as strictly deep or mixed-location ICH/microbleeds, with mixed-location indicating a more severe form.
• This study investigates the relationship between HTN-cSVD severity and long-term hypertension control after ICH.

Purpose of the Study:

• To test the hypothesis that more severe forms of HTN-cSVD are associated with poorer hypertension control during long-term follow-up.
• To explore the association between cSVD etiology/severity and systolic blood pressure (SBP) in ICH survivors.

Main Methods:

• Classified 796 non-traumatic ICH survivors into CAA, strictly deep ICH/microbleeds, and mixed-location ICH/microbleeds groups.
• Quantified cSVD burden using a validated MRI-based score (0-6 points).
• Employed a multivariable linear mixed-effects model to assess the association of average follow-up SBP with cSVD characteristics, adjusting for covariates.

Main Results:

• Survivors with CAA-related ICH had lower median SBP (138 mmHg) compared to strictly deep ICH (141 mmHg) and mixed-location ICH/microbleeds (142 mmHg).
• Mixed-location ICH/microbleeds (effect: +3.8 mmHg, p=0.01) and increasing cSVD severity (effect: +1.8 mmHg per score point, p=0.03) were significantly associated with higher follow-up SBP.
• Follow-up duration was a median of 48.8 months.

Conclusions:

• cSVD severity and subtype are significant predictors of long-term hypertension control in ICH patients.
• Patients with more severe cSVD, particularly mixed-location ICH/microbleeds, exhibit poorer hypertension management post-ICH.
• These findings highlight the importance of considering cSVD characteristics for tailored hypertension management strategies in ICH survivors.