Premorbid Blood Pressure Control Modifies Risk of DWI Lesions With Acute Blood Pressure Reduction in Intracerebral Hemorrhage.

IF 6.9 1区医学 Q1 PERIPHERAL VASCULAR DISEASE Hypertension Pub Date : 2024-07-29 DOI:10.1161/HYPERTENSIONAHA.124.23271

Mohamed Ridha, Yousef Hannawi, Santosh Murthy, Fernanda Carvalho Poyraz, Aditya Kumar, Soojin Park, David Roh, Padmini Sekar, Daniel Woo, James Burke

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Abstract

Background: Hypoperfusion due to blood pressure (BP) reduction is a potential mechanism of cerebral ischemia after intracerebral hemorrhage. However, prior evaluations of the relationship between BP reduction and ischemia have been conflicting. Untreated chronic hypertension is common in intracerebral hemorrhage and alters cerebral autoregulation. We hypothesized that the risk of diffusion-weighted imaging (DWI) hyperintensities from acute BP reduction is modified by premorbid BP control.

Methods: Individuals enrolled in the ERICH study (Ethnic/Racial Variations of Intracerebral Hemorrhage) from 2010 to 2015 were categorized as untreated, treated, or nonhypertensive based on preintracerebral hemorrhage diagnosis and antihypertensive medication use. The percent reduction of systolic BP (SBP) was calculated between presentation and 24 hours from admission. The primary outcome was the presence of DWI lesions. Using logistic regression, we tested the association between chronic hypertension status, SBP reduction, and their interaction with DWI lesion presence.

Results: From 3000 participants, 877 with available magnetic resonance imaging met inclusion (mean age, 60.5±13.3 years; 42.5% women). DWI lesions were detected in 25.9%. Untreated, treated, and no hypertension accounted for 32.6%, 47.9%, and 19.5% of cases, respectively. SBP reduction was not directly associated with DWI lesions; however, an interaction effect was observed between SBP reduction and chronic hypertension status (P=0.036). Nonhypertensive subjects demonstrated a linear risk of DWI lesion presence with greater SBP reduction, whereas untreated hypertension demonstrated a stable risk across a wide range of SBP reduction (P=0.023).

Conclusions: Premorbid BP control, especially untreated hypertension, may influence the relationship between DWI lesions and acute BP reduction after intracerebral hemorrhage.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01202864.

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病前血压控制可改变脑出血急性期血压降低导致 DWI 病变的风险

背景：血压降低导致的低灌注是脑出血后脑缺血的一个潜在机制。然而，之前对血压降低与脑缺血之间关系的评估并不一致。未经治疗的慢性高血压在脑出血中很常见，会改变脑的自动调节。我们假设，急性降压导致弥散加权成像（DWI）高密度的风险会受到病前血压控制的影响：2010年至2015年参加ERICH研究（脑出血的民族/种族变异）的人根据脑出血前的诊断和使用降压药的情况被分为未治疗、治疗和非降压。入院后 24 小时内的收缩压（SBP）降低百分比计算。主要结果是出现 DWI 病变。通过逻辑回归，我们检验了慢性高血压状态、SBP 下降率以及它们与 DWI 病变之间的相互关系：在 3000 名参与者中，有 877 人的磁共振成像符合纳入条件（平均年龄为 60.5±13.3 岁；42.5% 为女性）。25.9%的患者发现了 DWI 病变。未治疗、已治疗和无高血压的病例分别占 32.6%、47.9% 和 19.5%。SBP 下降与 DWI 病变没有直接关系；但观察到 SBP 下降与慢性高血压状态之间存在交互作用（P=0.036）。非高血压受试者出现DWI病变的线性风险随着SBP降低幅度的增加而增加，而未经治疗的高血压在SBP降低的较大范围内显示出稳定的风险（P=0.023）：结论：病前血压控制，尤其是未经治疗的高血压，可能会影响脑出血后 DWI 病变与急性降压之间的关系：URL: https://www.clinicaltrials.gov; Unique identifier：NCT01202864。

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来源期刊

Hypertension 医学-外周血管病

CiteScore

15.90

自引率

4.80%

发文量

1006

审稿时长

1 months

期刊介绍： Hypertension presents top-tier articles on high blood pressure in each monthly release. These articles delve into basic science, clinical treatment, and prevention of hypertension and associated cardiovascular, metabolic, and renal conditions. Renowned for their lasting significance, these papers contribute to advancing our understanding and management of hypertension-related issues.