Abstract 127: Untreated Hypertension after Intracerebral Hemorrhage

Objective: We previously reported that 46.9% of acute intracerebral hemorrhage (ICH) patients had untreated hypertension (HTN) on admission. We sought to investigate the prevalence of untreated HTN among patients at follow-up after ICH. Methods: ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) is a prospective multi-center study of ICH among whites, blacks, and Hispanics. Cases were enrolled at 42 recruitment sites. Subjects’ ethnicity, history of HTN, type of insurance, HTN medications, and level of education were collected. Patients were considered to have HTN if they received this diagnosis prior to or during initial ICH admission. Stroke events at follow-up included ischemic stroke, transient ischemic attack, subarachnoid hemorrhage, and recurrent ICH. Medication use was also recorded at follow-up. Results: Of 3,000 cases of ICH, there were 1,822 with HTN who had at least one follow-up, of which 9.4% had untreated HTN. Compared with treated patients at 3 months, those untreated at 3 months more frequently were white or Hispanic (p=0.0064), female (p=0.0236), over 65 years old (p<0.0001), or on Medicare (p<0.0001). Among those treated at 3 months, 60.5% were prescribed beta blockers, 54.9% calcium channel blockers, 52.9% ACE inhibitors, 31.5% diuretics, 16.6% vasodilators, 12.6% angiotensin receptor blockers, 10.3% alpha agonists, 2.8% nitrates, 2.5% alpha blockers, and 3.7% others. Stroke events occurred by 12 months in 5.5% of treated compared with 5.6% of untreated patients. Conclusions: Despite a high rate of untreated HTN at admission, the rate at follow-up was substantially lower. Overall, Hispanics were more likely and blacks less likely to be untreated than whites. Despite the lack of difference in stroke events identified among treated versus untreated patients, there was limited power to identify differences in a short-term follow-up due to a low rate of stroke recurrence and a low proportion of untreated HTN.