Blood Pressure Control and Recurrence of Hypertensive Brain Hemorrhage

Arakawa, Shuji; Saku, Yoshisuke; Ibayashi, Setsuro; Nagao, Tetsuhiko; Fujishima, Masatoshi

doi:10.1161/01.str.29.9.1806

Cited by 100 publications

(59 citation statements)

References 14 publications

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“…The rate of recurrent hemorrhage is approximately 2% per patient-year [129,130]. Several risk factors for recurrent ICH have been identified during the years, including older age [130], hypertension [129], lobar ICH location [131], possession of the apolipoprotein E ε2, or ε4 allele [132], and more microbleeds on gradient recalled echo MRI [51].…”

Section: Prevention Of Recurrent Ichmentioning

confidence: 99%

“…Several risk factors for recurrent ICH have been identified during the years, including older age [130], hypertension [129], lobar ICH location [131], possession of the apolipoprotein E ε2, or ε4 allele [132], and more microbleeds on gradient recalled echo MRI [51]. Of these, hypertension is an important and modifiable risk factor for recurrent hemorrhage.…”

Section: Prevention Of Recurrent Ichmentioning

confidence: 99%

“…Of these, hypertension is an important and modifiable risk factor for recurrent hemorrhage. In patients with a diastolic blood pressure greater than 90 mmHg, the recurrence rate of ICH is 10% per patient-year compared to 1.5% in patients with a diastolic blood pressure below 90 mmHg [129]. In the previously described Perindopril Protection against Recurrent Stroke Study (PROGRESS) trial, blood pressure lowering was also associated with a reduced risk of recurrent ICH [11].…”

Section: Prevention Of Recurrent Ichmentioning

confidence: 99%

See 2 more Smart Citations

Therapeutic Strategies in Acute Intracerebral Hemorrhage

Brouwers

Goldstein

2012

Neurotherapeutics

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Section: Prevention Of Recurrent Ichmentioning

confidence: 99%

Section: Prevention Of Recurrent Ichmentioning

confidence: 99%

Section: Prevention Of Recurrent Ichmentioning

confidence: 99%

See 1 more Smart Citation

Therapeutic Strategies in Acute Intracerebral Hemorrhage

Brouwers

Goldstein

2012

Neurotherapeutics

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“…24 In a prospective study of 74 patients with hypertensive brain haemorrhage, 24 higher diastolic BP was related to an increased rate of rebleeding. Recurrence rate was calculated to be 10.0% per patient-year among individuals with diastolic BP490 mmHg and o1.5% in those with lower diastolic BP.…”

Section: Bp and The Risk Of Primary And Secondary Ichmentioning

confidence: 99%

“…Many studies have identified hypertension as a major risk factor for the development of primary 7,9,23 and recurrent 24 ICH. The strength of association between BP and haemorrhagic stroke appears to be greater than that observed for ischaemic stroke.…”

Section: Bp and The Risk Of Primary And Secondary Ichmentioning

confidence: 99%

Blood pressure in acute intracerebral haemorrhage

et al. 2004

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Stroke is one of the leading causes of death worldwide, and spontaneous bleeding into the brain parenchyma, intracerebral haemorrhage (ICH), is a stroke subtype associated with high morbidity and mortality. Overall, it comprises about 15% of all stroke in Caucasians, this figure being much higher in Asians and black people. Blood pressure (BP) appears to play an important role in this disease. We have reviewed available literature on the relationship of BP to the occurrence of primary and secondary ICH, the association of BP levels measured early after stroke with prognosis and complications, and evidence about the effects of early BP lowering treatments on post-stroke outcomes. BP appears to be an important risk factor for primary and secondary ICH. In addition, high BP early after ICH may be detrimental to outcome, possibly contributing to complications such as rebleeding and haematoma enlargement. Few data are available about the effects of early lowering of BP on outcome after ICH with no reliable trial yet conducted. Proper randomised trials are required to establish the effect of early lowering of BP on outcome after ICH.

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Statin Use Following Intracerebral Hemorrhage

Westover¹,

Bianchi²,

Eckman³

et al. 2011

Arch Neurol

112

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Context: Statins are widely prescribed for primary and secondary prevention of ischemic cardiac and cerebrovascular disease. Although serious adverse effects are uncommon, results from a recent clinical trial suggested increased risk of intracerebral hemorrhage (ICH) associated with statin use. For patients with baseline elevated risk of ICH, it is not known whether this potential adverse effect offsets the cardiovascular and cerebrovascular benefits.Objective: To address the following clinical question: Given a history of prior ICH, should statin therapy be avoided?Design: A Markov decision model was used to evaluate the risks and benefits of statin therapy in patients with prior ICH.Main Outcome Measure: Life expectancy, measured as quality-adjusted life-years. We investigated how statin use affects this outcome measure while varying a range of clinical parameters, including hemorrhage location (deep vs lobar), ischemic cardiac and cerebrovascular risks, and magnitude of ICH risk associated with statins.Results: Avoiding statins was favored over a wide range of values for many clinical parameters, particularly in survivors of lobar ICH who are at highest risk of ICH recurrence. InsurvivorsoflobarICHwithoutpriorcardiovascularevents, avoiding statins yielded a life expectancy gain of 2.2 qualityadjusted life-years compared with statin use. This net benefit persisted even at the lower 95% confidence interval of the relative risk of statin-associated ICH. In patients with lobar ICH who had prior cardiovascular events, the annual recurrence risk of myocardial infarction would have to exceed 90% to favor statin therapy. Avoiding statin therapy was also favored, although by a smaller margin, in both primary and secondary prevention settings for survivors of deep ICH. Conclusions: Avoiding statins should be considered for patients with a history of ICH, particularly those cases with a lobar location.

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Blood Pressure Control and Recurrence of Hypertensive Brain Hemorrhage

Cited by 100 publications

References 14 publications

Therapeutic Strategies in Acute Intracerebral Hemorrhage

Therapeutic Strategies in Acute Intracerebral Hemorrhage

Blood pressure in acute intracerebral haemorrhage

Statin Use Following Intracerebral Hemorrhage

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