Abstract 15: Medication Inadequacy Accounts for Two-Third of Uncontrolled Hypertension Following Intracerebral Hemorrhage in a Multinational Study

Abstract

Introduction: Intracerebral hemorrhage (ICH) survivors often have severe hypertension and require multiple antihypertensive agents for blood pressure (BP) control. Adequate BP control is vital for ICH prevention, but the majority of ICH survivors have uncontrolled hypertension. To understand how we might improve BP control, we aimed to identify contributors to uncontrolled hypertension, and determine antihypertensive requirements as well as predictors of the need of ≥3 antihypertensives after ICH. Methods: We studied 1172 ICH survivors from two independent ICH cohorts: Massachusetts General Hospital (MGH) and the University of Hong Kong (HKU). We defined uncontrolled hypertension (BP ≥140/90 mmHg), inadequately medicated hypertension (uncontrolled hypertension on ≤2 antihypertensives), and resistant hypertension (uncontrolled hypertension on ≥3 antihypertensive classes or controlled hypertension on ≥4 classes) six months after ICH. Baseline predictors of the need for ≥3 antihypertensive agents were derived using multivariate logistic regression. Results: At six months post-ICH, 64.3% (502/781) of MGH ICH survivors and 32.7% (128/391) of HKU had uncontrolled hypertension. Resistant hypertension accounted for 33.5% and 29.7% of uncontrolled hypertension in the respective cohorts, while the remaining patients qualified for the designation of inadequately medicated hypertension. Excluding patients with inadequately medicated hypertension, 60.0% of patients in MGH and 37.2% in HKU required ≥3 antihypertensive agents. Age <65 years (odds ratio (OR) 1.80, p <0.001), admission systolic BP of >190 mmHg (OR 3.46, p <0.001) and a history of hypertension before ICH (OR 3.39, p <0.001) predicted the need for ≥3 antihypertensives after ICH. Conclusion: Medication inadequacy accounts for around two-thirds of uncontrolled hypertension after ICH, providing an opportunity for intervention to prevent hypertension-related complications, including ICH recurrence. As most ICH survivors required ≥3 antihypertensives for adequate BP control, early inpatient initiation of triple antihypertensive combination therapy should be considered, especially in patients with admission systolic BP of >190 mmHg, known hypertension and aged <65 years.