Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage

Stella Kidwell, Jonathan Rosand, Gina Norato, Simone Dixon, Bradford B. Worrall, Michael L. James, Mitchell S.V. Elkind, Matthew L. Flaherty, Jennifer Osborne, Anastasia Vashkevich, Carl D. Langefeld, Charles J. Moomaw, Daniel Woo

Research output: Contribution to journalArticle

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Abstract

Objective: To evaluate the associations among diffusion-weighted imaging (DWI) lesions, blood pressure (BP) dysregulation, MRI markers of small vessel disease, and poor outcome in a large, prospective study of primary intracerebral hemorrhage (ICH). Methods: The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a multicenter, observational study of ICH among white, black, and Hispanic patients. Results: Of 600 patients, mean (±SD) age was 60.8 ± 13.6 years, median (interquartile range) ICH volume was 9.1 mL (3.5-20.8), and 79.6% had hypertension. Overall, 26.5% of cases had DWI lesions, and this frequency differed by race/ethnicity (black 33.8%, Hispanic 24.9%, white 20.2%, overall p = 0.006). A logistic regression model of variables associated with DWI lesions included lower age (odds ratio [OR] 0.721, p = 0.002), higher first recorded systolic BP (10-unit OR 1.12, p = 0.002), greater change in mean arterial pressure (MAP) prior to the MRI (10-unit OR 1.10, p = 0.037), microbleeds (OR 1.99, p = 0.008), and higher white matter hyperintensity (WMH) score (1-unit OR 1.16, p = 0.002) after controlling for race/ethnicity, leukocyte count, and acute in-hospital antihypertensive treatment. A second model of variables associated with poor 90-day functional outcome (modified Rankin Scale scores 4-6) included DWI lesion count (OR 1.085, p = 0.034) as well as age, ICH volume, intraventricular hemorrhage, Glasgow Coma Scale score, WMH score, race/ethnicity, acute in-hospital antihypertensive treatment, and ICH location. Conclusions: These results support the hypotheses that acute BP dysregulation is associated with the development of DWI lesions in primary ICH and that DWI lesions are, in turn, associated with poor outcomes.

Original languageEnglish (US)
Pages (from-to)782-788
Number of pages7
JournalNeurology
Volume88
Issue number8
DOIs
StatePublished - Feb 21 2017

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Cerebral Hemorrhage
Blood Pressure
Odds Ratio
Hispanic Americans
Antihypertensive Agents
Logistic Models
Glasgow Coma Scale
Leukocyte Count
Multicenter Studies
Observational Studies
Arterial Pressure
Prospective Studies
Hemorrhage
Hypertension
Therapeutics

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Kidwell, S., Rosand, J., Norato, G., Dixon, S., Worrall, B. B., James, M. L., ... Woo, D. (2017). Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage. Neurology, 88(8), 782-788. https://doi.org/10.1212/WNL.0000000000003630

Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage. / Kidwell, Stella; Rosand, Jonathan; Norato, Gina; Dixon, Simone; Worrall, Bradford B.; James, Michael L.; Elkind, Mitchell S.V.; Flaherty, Matthew L.; Osborne, Jennifer; Vashkevich, Anastasia; Langefeld, Carl D.; Moomaw, Charles J.; Woo, Daniel.

In: Neurology, Vol. 88, No. 8, 21.02.2017, p. 782-788.

Research output: Contribution to journalArticle

Kidwell, S, Rosand, J, Norato, G, Dixon, S, Worrall, BB, James, ML, Elkind, MSV, Flaherty, ML, Osborne, J, Vashkevich, A, Langefeld, CD, Moomaw, CJ & Woo, D 2017, 'Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage', Neurology, vol. 88, no. 8, pp. 782-788. https://doi.org/10.1212/WNL.0000000000003630
Kidwell, Stella ; Rosand, Jonathan ; Norato, Gina ; Dixon, Simone ; Worrall, Bradford B. ; James, Michael L. ; Elkind, Mitchell S.V. ; Flaherty, Matthew L. ; Osborne, Jennifer ; Vashkevich, Anastasia ; Langefeld, Carl D. ; Moomaw, Charles J. ; Woo, Daniel. / Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage. In: Neurology. 2017 ; Vol. 88, No. 8. pp. 782-788.
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AU - Rosand, Jonathan

AU - Norato, Gina

AU - Dixon, Simone

AU - Worrall, Bradford B.

AU - James, Michael L.

AU - Elkind, Mitchell S.V.

AU - Flaherty, Matthew L.

AU - Osborne, Jennifer

AU - Vashkevich, Anastasia

AU - Langefeld, Carl D.

AU - Moomaw, Charles J.

AU - Woo, Daniel

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N2 - Objective: To evaluate the associations among diffusion-weighted imaging (DWI) lesions, blood pressure (BP) dysregulation, MRI markers of small vessel disease, and poor outcome in a large, prospective study of primary intracerebral hemorrhage (ICH). Methods: The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a multicenter, observational study of ICH among white, black, and Hispanic patients. Results: Of 600 patients, mean (±SD) age was 60.8 ± 13.6 years, median (interquartile range) ICH volume was 9.1 mL (3.5-20.8), and 79.6% had hypertension. Overall, 26.5% of cases had DWI lesions, and this frequency differed by race/ethnicity (black 33.8%, Hispanic 24.9%, white 20.2%, overall p = 0.006). A logistic regression model of variables associated with DWI lesions included lower age (odds ratio [OR] 0.721, p = 0.002), higher first recorded systolic BP (10-unit OR 1.12, p = 0.002), greater change in mean arterial pressure (MAP) prior to the MRI (10-unit OR 1.10, p = 0.037), microbleeds (OR 1.99, p = 0.008), and higher white matter hyperintensity (WMH) score (1-unit OR 1.16, p = 0.002) after controlling for race/ethnicity, leukocyte count, and acute in-hospital antihypertensive treatment. A second model of variables associated with poor 90-day functional outcome (modified Rankin Scale scores 4-6) included DWI lesion count (OR 1.085, p = 0.034) as well as age, ICH volume, intraventricular hemorrhage, Glasgow Coma Scale score, WMH score, race/ethnicity, acute in-hospital antihypertensive treatment, and ICH location. Conclusions: These results support the hypotheses that acute BP dysregulation is associated with the development of DWI lesions in primary ICH and that DWI lesions are, in turn, associated with poor outcomes.

AB - Objective: To evaluate the associations among diffusion-weighted imaging (DWI) lesions, blood pressure (BP) dysregulation, MRI markers of small vessel disease, and poor outcome in a large, prospective study of primary intracerebral hemorrhage (ICH). Methods: The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a multicenter, observational study of ICH among white, black, and Hispanic patients. Results: Of 600 patients, mean (±SD) age was 60.8 ± 13.6 years, median (interquartile range) ICH volume was 9.1 mL (3.5-20.8), and 79.6% had hypertension. Overall, 26.5% of cases had DWI lesions, and this frequency differed by race/ethnicity (black 33.8%, Hispanic 24.9%, white 20.2%, overall p = 0.006). A logistic regression model of variables associated with DWI lesions included lower age (odds ratio [OR] 0.721, p = 0.002), higher first recorded systolic BP (10-unit OR 1.12, p = 0.002), greater change in mean arterial pressure (MAP) prior to the MRI (10-unit OR 1.10, p = 0.037), microbleeds (OR 1.99, p = 0.008), and higher white matter hyperintensity (WMH) score (1-unit OR 1.16, p = 0.002) after controlling for race/ethnicity, leukocyte count, and acute in-hospital antihypertensive treatment. A second model of variables associated with poor 90-day functional outcome (modified Rankin Scale scores 4-6) included DWI lesion count (OR 1.085, p = 0.034) as well as age, ICH volume, intraventricular hemorrhage, Glasgow Coma Scale score, WMH score, race/ethnicity, acute in-hospital antihypertensive treatment, and ICH location. Conclusions: These results support the hypotheses that acute BP dysregulation is associated with the development of DWI lesions in primary ICH and that DWI lesions are, in turn, associated with poor outcomes.

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