Abstract
Hypertension (HTN) is the most common cause of spontaneous intracerebral hemorrhage (ICH). The aim of this study is to investigate the role of resistant HTN in patients with ICH. We conducted a retrospective study of all consecutive ICH admissions at our medical center from November 2013 to October 2015. The clinical features of patients with resistant HTN (requiring four or more antihypertensive agents to keep systolic blood pressure <140 mm Hg) were compared with those with responsive HTN (requiring three or fewer agents). Of the 152 patients with hypertensive ICH, 48 (31.6%) had resistant HTN. Resistant HTN was independently associated with higher body mass index and proteinuria. Compared to the responsive group, patients with resistant HTN had higher initial blood pressures and greater requirement for ventilator support, hematoma evacuation, hypertonic saline therapy, and nicardipine infusion. Resistant HTN increases length of stay (LOS) in the intensive care unit (ICU) (4.2 vs 2.1 days; p = 0.007) and in the hospital (11.5 vs 7.0 days; p = 0.003). Multivariate regression analysis showed that the rate of systolic blood pressure >140 mm Hg and duration of nicardipine infusion were independently associated with LOS in the ICU. There was no significant difference in hematoma expansion and functional outcome at hospital discharge between the two groups. Resistant HTN in patients with ICH is associated with more medical interventions and longer LOS without effecting outcome at hospital discharge.
Highlights
Uncontrolled hypertension (HTN) is the most common cause of spontaneous intracerebral hemorrhage (ICH) [1, 2]
The patients with resistant HTN were associated with younger age, obstructive sleep apnea, chronic renal failure, higher initial blood pressures, increased serum creatinine, and proteinuria
After adjustment for age, race, and gender, logistic regression analysis showed that body mass index (BMI) and proteinuria were independently associated with resistant HTN
Summary
Uncontrolled hypertension (HTN) is the most common cause of spontaneous intracerebral hemorrhage (ICH) [1, 2]. Hypertensive ICH is a type of stroke with intraparenchymal bleeding from hypertensive damage to blood vessel walls. The predilection sites for hypertensive ICH include the basal ganglia (40–50%), lobar regions (20–50%), thalamus (10–15%), pons (5–12%), cerebellum (5–10%), and other brainstem sites (1–5%) [3, 4]. Data from numerous studies have identified high systolic blood pressure (SBP) as the major risk factor for ICH [5,6,7]. Hypertension (HTN) is the most common cause of spontaneous intracerebral hemorrhage (ICH).
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