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Three important subgroups of hypertensive persons at greater risk of intracerebral hemorrhage. Melbourne Risk Factor
A G Thrift1, J J McNeil, A Forbes
1Department of Epidemiology and Preventive Medicine, Monash Medical School, Alfred Hospital, Prahran, Victoria, Australia. thrift@austin.unimelb.edu.au
Insights
Hypertension significantly increases intracerebral hemorrhage (ICH) risk, especially in younger individuals, smokers, and those stopping antihypertensive medications. This highlights the need for targeted monitoring and risk factor management.
Area of Science:
- Neurology
- Cardiology
- Epidemiology
Background:
- Hypertension is a known risk factor for intracerebral hemorrhage (ICH).
- The precise quantification of this risk, particularly with modern antihypertensive treatments, requires further investigation.
- Understanding risk stratification is crucial for stroke prevention strategies.
Purpose of the Study:
- To quantify the risk of primary intracerebral hemorrhage (ICH) associated with hypertension.
- To examine how factors like age, smoking, and antihypertensive medication use modify this risk.
- To investigate the differential impact of hypertension on ICH mortality versus survival.
Main Methods:
- A case-control study involving 331 primary ICH patients and 331 matched community controls.
- Data collected from hospital records and city-wide registries between 1990-1992.
- Statistical analysis using odds ratios (OR) and confidence intervals (CI) to assess risk factors.
Main Results:
- Hypertension was associated with a nearly 2.5-fold increased risk of ICH (OR, 2.45).
- The risk was substantially higher in individuals who had stopped antihypertensive medication (OR, 4.98), were under 55 (OR, 7.68), or were current smokers (OR, 6.12).
- Hypertension posed a greater ICH risk for non-survivors compared to survivors (OR ratio, 5.47).
Conclusions:
- Hypertension significantly elevates ICH risk, with heightened risk observed in younger individuals, smokers, and those discontinuing antihypertensive therapy.
- This study provides the first direct evidence linking cessation of antihypertensive medication to increased stroke risk.
- Targeted interventions for high-risk groups, including enhanced monitoring and education, are recommended to mitigate ICH incidence and impact.
Abstract:
Hypertension as a risk factor for intracerebral hemorrhage (ICH) is poorly quantified, particularly in the setting of the use of modern antihypertensive agents. To investigate this, we studied 331 consecutive hospital cases of primary ICH verified by computed tomography or autopsy, occurring during the period 1990 through 1992, and 331 age- and sex-matched community-based control subjects in a city-wide study involving 13 hospitals. Hypertension approximately doubled the risk of ICH (adjusted odds ratio [OR], 2.45; 95% confidence interval [CI], 1.61 to 3.73). The OR associated with hypertension was significantly greater among those who had ceased taking medications, supervised and unsupervised (OR, 4.98; 95% CI, 2.25 to 11.02), compared with those who had not (OR, 1.95; 95% CI, 1.20 to 3.16), were under the age of 55 years (OR, 7.68; 95% CI, 2.65 to 22.5), or were current smokers (OR, 6.12; 95% CI, 2.29 to 16.35). The presence of hypertension did not influence size or location of the hemorrhage. However, those dying from ICH displayed a greater risk of ICH due to hypertension than survivors, with the ratio of the two ORs being 5.47 (95% CI, 1.23 to 24.44). These findings provide evidence for a greater increase in risk of ICH due to hypertension among younger persons, current smokers, and those discontinuing antihypertensive therapy. This is the first direct evidence for a link between stopping antihypertensive medication use and stroke risk; targeting these individuals for more intensive monitoring and education on the importance of risk factor modification may help to reduce the impact of this form of stroke.