Abstract TP428: Hypertension Severity and Stroke Recurrence Risk among Oldest Old Intracerebral Hemorrhage Survivors

Abstract

Introduction: Oldest old (age ≥80 years) survivors of Intracerebral Hemorrhage (ICH) may be at higher risk for stroke recurrence, reflecting increasing hypertension severity with aging. Dedicated longitudinal studies of ICH in the oldest old are lacking, yet urgently needed as they represent an ever-increasing proportion of survivors. We sought to determine whether: 1) oldest old ICH survivors are at higher risk for stroke recurrence; 2) hypertension severity accounts for disparities in stroke recurrence risk across age categories. Methods: We analyzed data from survivors of primary ICH, enrolled in a single-center prospective study. Exposures of interest include patients’ demographics, medical history, ICH characteristics, Blood Pressure (BP) measurements and medications exposures during follow-up. Outcomes of interest included ICH and/or ischemic stroke events during follow-up. Results: We enrolled 1464 ICH survivors (441 ≥80 years and 1023 <80 years). In multivariable analyses lobar ICH location, white non-Hispanic background and female gender were independently associated with ICH at age ≥80 years (all p<0.05). ICH survivors age ≥80 years had higher systolic BP during follow-up (≥80 years: median 148 mmHg, IQR 139-156 vs. <80 years: median 138, IQR 132-145, p<0.001), but they were less likely to receive anti-hypertensive treatment (≥80 years: 233/442, 53% vs <80 years: 603/1023, 59%, p=0.003). Hypertension severity interacted with advancing age (interaction p<0.001) to further increase stroke recurrence risk among oldest old ICH survivors with frank hypertension (Figure 1). Conclusion: Oldest old ICH survivors are more likely to be female, white non-Hispanic, to present with lobar ICH, and to demonstrate inadequate blood pressure control. They are at higher risk for stroke recurrence, with hypertension severity playing a pivotal role. Future ICH studies will benefit from focusing on blood pressure control among oldest old survivors.