Hypertension control after intracerebral hemorrhage among varying small vessel disease etiologies.

IF 2.7 4区医学 Q2 CLINICAL NEUROLOGY

Neurological Sciences Pub Date : 2024-10-01 Epub Date: 2024-05-21 DOI:10.1007/s10072-024-07560-2

Alvin S Das, Akashleena Mallick, Samantha A Mora, Sophia Keins, Jessica R Abramson, Juan Pablo Castello, Marco Pasi, Christina E Kourkoulis, Axana Rodriguez-Torres, Andrew D Warren, Elif Gökçal, Anand Viswanathan, Steven M Greenberg, Christopher D Anderson, Jonathan Rosand, Alessandro Biffi, M Edip Gurol

{"title":"Hypertension control after intracerebral hemorrhage among varying small vessel disease etiologies.","authors":"Alvin S Das, Akashleena Mallick, Samantha A Mora, Sophia Keins, Jessica R Abramson, Juan Pablo Castello, Marco Pasi, Christina E Kourkoulis, Axana Rodriguez-Torres, Andrew D Warren, Elif Gökçal, Anand Viswanathan, Steven M Greenberg, Christopher D Anderson, Jonathan Rosand, Alessandro Biffi, M Edip Gurol","doi":"10.1007/s10072-024-07560-2","DOIUrl":null,"url":null,"abstract":"Introduction: Intracerebral hemorrhage (ICH) is attributable to cerebral small vessel disease (cSVD), which includes cerebral amyloid angiopathy (CAA) and hypertensive-cSVD (HTN-cSVD). HTN-cSVD includes patients with strictly deep ICH/microbleeds and mixed location ICH/microbleeds, the latter representing a more severe form of HTN-cSVD. We test the hypothesis that more severe forms of HTN-cSVD are related to worse hypertension control in long-term follow-up after ICH.Methods: From consecutive non-traumatic ICH patients admitted to a tertiary care center, we classified the ICH as CAA, strictly deep ICH/microbleeds, and mixed-location ICH/microbleeds. CSVD burden was quantified using a validated MRI-based score (range: 0-6 points). We created a multivariable (linear mixed effects) model adjusting for age, sex, race, year of inclusion, hypertension, and antihypertensive medication usage to investigate the association of average systolic blood pressure (SBP) during follow-up with cSVD etiology/severity.Results: 796 ICH survivors were followed for a median of 48.8 months (IQR 41.5-60.4). CAA-related ICH survivors (n = 373) displayed a lower median SBP (138 mmHg, IQR 133-142 mmHg) compared to those of strictly deep ICH (n = 222, 141 mmHg, IQR 136-143 mmHg, p = 0.04), and mixed location ICH/microbleeds (n = 201, 142 mmHg, IQR 135-144 mmHg, p = 0.02). In the multivariable analysis, mixed location ICH/microbleeds (effect: + 3.8 mmHg, SE: 1.3 mmHg, p = 0.01) and increasing cSVD severity (+ 1.8 mmHg per score point, SE: 0.8 mmHg, p = 0.03) were associated with higher SBP in follow-up.Conclusion: CSVD severity and subtype predicts long-term hypertension control in ICH patients.","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":null,"pages":null},"PeriodicalIF":2.7000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurological Sciences","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10072-024-07560-2","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/5/21 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: Intracerebral hemorrhage (ICH) is attributable to cerebral small vessel disease (cSVD), which includes cerebral amyloid angiopathy (CAA) and hypertensive-cSVD (HTN-cSVD). HTN-cSVD includes patients with strictly deep ICH/microbleeds and mixed location ICH/microbleeds, the latter representing a more severe form of HTN-cSVD. We test the hypothesis that more severe forms of HTN-cSVD are related to worse hypertension control in long-term follow-up after ICH.

Methods: From consecutive non-traumatic ICH patients admitted to a tertiary care center, we classified the ICH as CAA, strictly deep ICH/microbleeds, and mixed-location ICH/microbleeds. CSVD burden was quantified using a validated MRI-based score (range: 0-6 points). We created a multivariable (linear mixed effects) model adjusting for age, sex, race, year of inclusion, hypertension, and antihypertensive medication usage to investigate the association of average systolic blood pressure (SBP) during follow-up with cSVD etiology/severity.

Results: 796 ICH survivors were followed for a median of 48.8 months (IQR 41.5-60.4). CAA-related ICH survivors (n = 373) displayed a lower median SBP (138 mmHg, IQR 133-142 mmHg) compared to those of strictly deep ICH (n = 222, 141 mmHg, IQR 136-143 mmHg, p = 0.04), and mixed location ICH/microbleeds (n = 201, 142 mmHg, IQR 135-144 mmHg, p = 0.02). In the multivariable analysis, mixed location ICH/microbleeds (effect: + 3.8 mmHg, SE: 1.3 mmHg, p = 0.01) and increasing cSVD severity (+ 1.8 mmHg per score point, SE: 0.8 mmHg, p = 0.03) were associated with higher SBP in follow-up.

Conclusion: CSVD severity and subtype predicts long-term hypertension control in ICH patients.

Abstract Image

查看原文本刊更多论文

不同小血管疾病病因导致的脑内出血后高血压控制情况。

导言：脑出血（ICH）可归因于脑小血管疾病（cSVD），包括脑淀粉样血管病（CAA）和高血压-脑小血管疾病（HTN-cSVD）。高血压性脑血管病（HTN-cSVD）包括严格意义上的深部 ICH/微血栓和混合位置 ICH/微血栓患者，后者代表了高血压性脑血管病（HTN-cSVD）的更严重形式。我们对以下假设进行了验证：在 ICH 后的长期随访中，更严重形式的 HTN-cSVD 与更差的高血压控制有关：方法：从一家三级医疗中心连续收治的非创伤性 ICH 患者中，我们将 ICH 分为 CAA、严格深部 ICH/微出血和混合位置 ICH/微出血。CSVD 负荷通过基于 MRI 的有效评分进行量化（评分范围：0-6 分）。我们建立了一个多变量（线性混合效应）模型，对年龄、性别、种族、纳入年份、高血压和降压药使用情况进行了调整，以研究随访期间平均收缩压（SBP）与 cSVD 病因/严重程度的关系：对 796 名 ICH 幸存者进行了中位 48.8 个月（IQR 41.5-60.4）的随访。CAA 相关 ICH 存活者（n = 373）的中位 SBP（138 mmHg，IQR 133-142 mmHg）低于单纯深部 ICH 存活者（n = 222，141 mmHg，IQR 136-143 mmHg，p = 0.04）和混合位置 ICH/微出血（n = 201，142 mmHg，IQR 135-144 mmHg，p = 0.02）。在多变量分析中，混合位置 ICH/微出血（影响：+ 3.8 mmHg，SE：1.3 mmHg，p = 0.01）和 cSVD 严重程度的增加（每个评分点 + 1.8 mmHg，SE：0.8 mmHg，p = 0.03）与随访期间较高的 SBP 相关：结论：CSVD 严重程度和亚型可预测 ICH 患者的长期高血压控制情况。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Neurological Sciences 医学-临床神经学

CiteScore

6.10

自引率

3.00%

发文量

743

审稿时长

4 months

期刊介绍： Neurological Sciences is intended to provide a medium for the communication of results and ideas in the field of neuroscience. The journal welcomes contributions in both the basic and clinical aspects of the neurosciences. The official language of the journal is English. Reports are published in the form of original articles, short communications, editorials, reviews and letters to the editor. Original articles present the results of experimental or clinical studies in the neurosciences, while short communications are succinct reports permitting the rapid publication of novel results. Original contributions may be submitted for the special sections History of Neurology, Health Care and Neurological Digressions - a forum for cultural topics related to the neurosciences. The journal also publishes correspondence book reviews, meeting reports and announcements.