Role of cerebral amyloid angiopathy in intracerebral hemorrhage in hypertensive patients

Ritter, Martin; Droste, Dirk W.; Hegedüs, K.; Szepesi, Rita; Nabavi, Darius G.; Csiba, László; Ringelstein, E. B.

doi:10.1212/01.wnl.0000156522.93403.c3

Cited by 86 publications

(85 citation statements)

References 28 publications

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“…8,20 A recent autopsy study showed that severe hypertension was related to nonlobar, but not to lobar PICH. 9 Our results suggest that elevated blood pressure is related to both PICH subtypes, in particular nonlobar PICH, both in terms of absolute and relative risks. This is in line with the results of a recent meta-analysis 21 in which, however, only qualitative data on prestroke hypertension, in most cases established after a stroke event, was available.…”

Section: Discussionmentioning

confidence: 60%

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Blood Pressure in Relation to the Incidence of Cerebral Infarction and Intracerebral Hemorrhage

Zia

Hedblad

Pessah‐Rasmussen

et al. 2007

Stroke

142

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Background and Purpose-Data regarding the association between blood pressure level and incidence of stroke subtype, especially primary intracerebral hemorrhage (PICH) subtypes, is sparse. This population-based study explored the relationship between blood pressure and the incidence of cerebral infarction, and PICH, with lobar and nonlobar location. Methods-Risk factors were assessed in 27 702 men and women without prior stroke from the city of Malmö, Sweden. Results-Mean age was 58.1 years. In all, 701 subjects had stroke (613 cerebral infarction and 88 PICH) during the follow-up period (mean, 7.5 years). The age-and sex-standardized incidences of cerebral infarction in subjects with hypertension grade 3 (Ն180/110 mm Hg) and normal blood pressure (Ͻ140/90 mm Hg) were 6.8 and 1.7 per 1000 person-years, respectively. Compared with the normotensive group, the adjusted relative risk of cerebral infarction was 3.4 (95% CI: 2.6 to 4.5) in subjects with hypertension grade 3. The corresponding incidences of lobar PICH were 0.5 versus 0.08 per 1000 person-years, respectively (adjusted relative risk: 9.2, 95% CI: 2.6 to 32.6) and for nonlobar PICH 1.6 versus 0.09 per 1000 person-years, respectively (adjusted relative risk: 25.9, 95% CI: 8.2 to 82.3). Conclusions-The incidence of hemorrhagic and ischemic stroke increased progressively with increasing blood pressure.Although hypertension was associated with substantially higher incidence rates and absolute numbers of cerebral infarction, which is most important in the public health perspective, the relationship with nonlobar PICH was strongest in terms of relative risks.

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Section: Discussionmentioning

confidence: 60%

“…8 However, most previous studies in this field are case-control studies 7,8 or studies that only include fatal cases. 9,10 Here, we have prospectively studied the effects of hypertension on the absolute and relative risks of ischemic stroke, PICH, and PICH with lobar and nonlobar location.…”

mentioning

confidence: 99%

Blood Pressure in Relation to the Incidence of Cerebral Infarction and Intracerebral Hemorrhage

Zia

Hedblad

Pessah‐Rasmussen

et al. 2007

Stroke

142

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“…In addition to the possibility that patients concomitantly had CAA and HA, 22 our findings indicate the possibility that clinical differentiation between CAA and HA is not straightforward in some cases of ICH. The classification accuracy of HA and CAA based on hemorrhage patterns in brain images has been reported to be only 66.8%.…”

Section: Discussionmentioning

confidence: 70%

Pathogenetical Subtypes of Recurrent Intracerebral Hemorrhage

Yeh

Tang

Tsai

et al. 2014

Stroke

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Background and Purpose-Pathogenetic classification of intracerebral hemorrhage (ICH), using systems such as SMASH-U (structural vascular lesions, medication, cerebral amyloid angiopathy [CAA], systemic disease, hypertension, or undetermined), is important in predicting functional outcomes and mortality in patients with ICH. This study aimed to compare pathogenetic subtypes between the first and recurrent ICH. Methods-This study obtained data related to 4578 consecutive acute patients with ICH from the National Taiwan University Hospital Stroke Registry during January 1995 to December 2013. Using the SMASH-U method, patients were classified into 6 subtypes. We then analyzed the outcomes of first-ever ICH cases and pathogenetic classification of recurrent ICH. Results-Among 3785 patients who experienced first-ever ICH (male, 63.3%; mean age, 58.7±17.0 years), the most common cause was hypertensive angiopathy (54.9%), followed by CAA (12.2%), systemic disease (12.1%), undetermined (10.1%), structural vascular lesions (7.8%), and medication related (2.9%). In 185 cases of recurrent ICH, pathogenetic differences between the 2 ICH events were observed in 34 (18.4%) cases, most of which were CAA to hypertensive angiopathy (n=10) or vice versa (n=7). The rates of ICH recurrence were highest for systemic disease-related and CAA-related ICH at 1, 5, 10, and 15 years after the indexed ICH event. Conclusions-In

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“…32 A second postmortem study in hypertensive patients similarly demonstrated that CAA was associated with not only lobar but also deep brain hemorrhage. 33 These findings indicate that CAA may also play a role in hemorrhage in patients with more evident risk factors. The structural changes in the vascular wall related to CAA are associated with fibrinoid necrosis, focal vessel wall fragmentation and microaneurysms, which all predispose to blood vessel leakage.…”

Section: Discussionmentioning

confidence: 90%

Silent cerebral microbleeds associated with arterial stiffness in an apparently healthy subject

et al. 2009

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Silent cerebral microbleeds (MBs) are a common finding in stroke patients, especially those with intracerebral hemorrhage, and are thought to be a marker of future cerebral hemorrhage. Clinically, two distinct forms of MBs have been documented, those observed with either or both stroke or small vessel disease (SVD) and those associated with cerebral amyloid angiopathy. We investigated a possible association between MBs and arterial stiffness in a general population. Subjects were 443 apparently healthy individuals with a mean age of 67.1 ± 8.1 years. The presence of MBs, lacunar infarcts and periventricular hyperintensity (PVH) was determined by 3-tesla magnetic resonance imaging. Carotid intima-media thickness (IMT) was measured by ultrasonography. Arterial stiffness was evaluated by brachial-to-ankle pulse wave velocity (baPWV), and the Framingham stroke risk score (FSRS) was obtained as an integrated cerebrovascular risk factor. The prevalence of MBs was 5.0%. Both baPWV and FSRS were significantly higher in subjects with MBs (1820 ± 308 vs. 1645 ± 325 cm/s, P¼0.014 and 12.1 ± 8.6 vs. 8.9 ± 7.5%, P¼0.047, respectively). Odds ratio of a high baPWV, defined as X1500 cm/s, for the presence of MBs was 6.05 even after correction for confounding parameters, including age and hypertension. This association with high baPWV remained irrespective of MBs location, whether strictly located in the lobes or in the basal ganglia and infratentorial regions. These findings indicate an association between arterial stiffness and the presence of MBs. Assessment of arterial stiffness may be useful in identifying subjects at high risk for the presence of MBs.

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Role of cerebral amyloid angiopathy in intracerebral hemorrhage in hypertensive patients

Abstract: Cerebral amyloid angiopathy plays a major role in the pathogenesis of intracerebral hemorrhage even in patients with more evident risk factors.

Cited by 86 publications

References 28 publications

Blood Pressure in Relation to the Incidence of Cerebral Infarction and Intracerebral Hemorrhage

Blood Pressure in Relation to the Incidence of Cerebral Infarction and Intracerebral Hemorrhage

Pathogenetical Subtypes of Recurrent Intracerebral Hemorrhage

Silent cerebral microbleeds associated with arterial stiffness in an apparently healthy subject

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