Biological and Social Determinants of Hypertension Severity Before vs After Intracerebral Hemorrhage.

Black or African American Aged Cerebral Hemorrhage / complications Humans Hypertension / complications Male Risk Factors Social Determinants of Health White People

Journal

Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060

Informations de publication

Date de publication:
29 03 2022
Historique:
received: 12 07 2021
accepted: 03 01 2022
pubmed: 9 2 2022
medline: 7 4 2022
entrez: 8 2 2022
Statut: ppublish

Résumé

Although blood pressure (BP) control is considered the most effective measure to prevent functional decline after intracerebral hemorrhage (ICH), fewer than half of survivors achieve treatment goals. We hypothesized that long-term (i.e., prehemorrhage) hypertension severity may be a crucial factor in explaining poor BP control after ICH. We investigated changes in hypertension severity after vs before ICH using latent class analysis (LCA) and identified patient characteristics predictive of individuals' BP trajectories. We analyzed data for ICH survivors enrolled in a study conducted at Massachusetts General Hospital (MGH) from 2002 to 2019 in Boston, a high-resource setting with near-universal medical insurance coverage. We captured BP measurements in the 12 months preceding and following the acute ICH hospitalization. Using LCA, we identified patient groups (classes) based on changes in hypertension severity over time in an unbiased manner. We then created multinomial logistic regression models to identify patient factors associated with these classes. Among 336 participants, the average age was 74.4 years, 166 (49%) were male, and 288 (86%) self-reported White race/ethnicity. LCA identified 3 patient classes, corresponding to minimal (n = 114, 34%), intermediate (n = 128, 38%), and substantial (n = 94, 28%) improvement in hypertension severity after vs before ICH. Survivors with undertreated (relative risk ratio [RRR] 0.05, 95% CI 0.01-0.23) or resistant (RRR 0.03, 95% CI 0.01-0.06) hypertension before ICH were less likely to experience substantial improvement afterwards. Residents of high-income neighborhoods were more likely to experience substantial improvement (RRR 1.14 per $10,000, 95% CI 1.02-1.28). Black, Hispanic, and Asian participants with uncontrolled hypertension before ICH were more likely to experience minimal improvement after hemorrhagic stroke (interaction Most ICH survivors do not display consistent improvement in hypertension severity after hemorrhagic stroke. BP control after ICH is profoundly influenced by patient characteristics predating the hemorrhage, chiefly prestroke hypertension severity and socioeconomic status. Neighborhood income was associated with hypertension severity after ICH in a high-resource setting with near-universal health care coverage. These findings likely contribute to previously documented racial/ethnic disparities in BP control and clinical outcomes following ICH.

Sections du résumé

BACKGROUND AND OBJECTIVES
Although blood pressure (BP) control is considered the most effective measure to prevent functional decline after intracerebral hemorrhage (ICH), fewer than half of survivors achieve treatment goals. We hypothesized that long-term (i.e., prehemorrhage) hypertension severity may be a crucial factor in explaining poor BP control after ICH. We investigated changes in hypertension severity after vs before ICH using latent class analysis (LCA) and identified patient characteristics predictive of individuals' BP trajectories.
METHODS
We analyzed data for ICH survivors enrolled in a study conducted at Massachusetts General Hospital (MGH) from 2002 to 2019 in Boston, a high-resource setting with near-universal medical insurance coverage. We captured BP measurements in the 12 months preceding and following the acute ICH hospitalization. Using LCA, we identified patient groups (classes) based on changes in hypertension severity over time in an unbiased manner. We then created multinomial logistic regression models to identify patient factors associated with these classes.
RESULTS
Among 336 participants, the average age was 74.4 years, 166 (49%) were male, and 288 (86%) self-reported White race/ethnicity. LCA identified 3 patient classes, corresponding to minimal (n = 114, 34%), intermediate (n = 128, 38%), and substantial (n = 94, 28%) improvement in hypertension severity after vs before ICH. Survivors with undertreated (relative risk ratio [RRR] 0.05, 95% CI 0.01-0.23) or resistant (RRR 0.03, 95% CI 0.01-0.06) hypertension before ICH were less likely to experience substantial improvement afterwards. Residents of high-income neighborhoods were more likely to experience substantial improvement (RRR 1.14 per $10,000, 95% CI 1.02-1.28). Black, Hispanic, and Asian participants with uncontrolled hypertension before ICH were more likely to experience minimal improvement after hemorrhagic stroke (interaction
DISCUSSION
Most ICH survivors do not display consistent improvement in hypertension severity after hemorrhagic stroke. BP control after ICH is profoundly influenced by patient characteristics predating the hemorrhage, chiefly prestroke hypertension severity and socioeconomic status. Neighborhood income was associated with hypertension severity after ICH in a high-resource setting with near-universal health care coverage. These findings likely contribute to previously documented racial/ethnic disparities in BP control and clinical outcomes following ICH.

Identifiants

DOI: 10.1212/WNL.0000000000200003 PMID: 35131909 PMC: PMC8967426
pubmed: 35131909
pii: WNL.0000000000200003
doi: 10.1212/WNL.0000000000200003
pmc: PMC8967426
doi:

Types de publication

Journal Article Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

e1349-e1360

Subventions

Organisme : NIA NIH HHS
ID : R21 AG071796
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG059733
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS093870
Pays : United States
Organisme : NHGRI NIH HHS
ID : UM1 HG008895
Pays : United States
Organisme : NINDS NIH HHS
ID : R24 NS092983
Pays : United States
Organisme : NINDS NIH HHS
ID : U01 NS069763
Pays : United States
Organisme : NIMHD NIH HHS
ID : R01 MD011516
Pays : United States
Organisme : NINDS NIH HHS
ID : K23 NS100816
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS036695
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS103924
Pays : United States
Organisme : NIMHD NIH HHS
ID : U01 MD010579
Pays : United States

Informations de copyright

© 2022 American Academy of Neurology.

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Auteurs

Jessica R Abramson (JR)

From the Henry and Allison McCance Center for Brain Health (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., J.Q.A.H., C.D.A., J.R., A.B.), Department of Neurology (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., A.D.W., J.Q.A.H., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), and Center for Genomic Medicine (J.R.A., S.K., C.K., E.P.M., J.Q.A.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; School of Medicine (A.R.-T.), University of California, Irvine; Department of Neurology (A.T.), Keck School of Medicine, University of Southern California, Los Angeles; Los Angeles County Department of Health Services (A.T.), CA; Stroke Program (L.S.), University of Michigan Medical School, Ann Arbor; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA.

Juan Pablo Castello (JP)

From the Henry and Allison McCance Center for Brain Health (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., J.Q.A.H., C.D.A., J.R., A.B.), Department of Neurology (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., A.D.W., J.Q.A.H., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), and Center for Genomic Medicine (J.R.A., S.K., C.K., E.P.M., J.Q.A.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; School of Medicine (A.R.-T.), University of California, Irvine; Department of Neurology (A.T.), Keck School of Medicine, University of Southern California, Los Angeles; Los Angeles County Department of Health Services (A.T.), CA; Stroke Program (L.S.), University of Michigan Medical School, Ann Arbor; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA.

Sophia Keins (S)

From the Henry and Allison McCance Center for Brain Health (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., J.Q.A.H., C.D.A., J.R., A.B.), Department of Neurology (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., A.D.W., J.Q.A.H., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), and Center for Genomic Medicine (J.R.A., S.K., C.K., E.P.M., J.Q.A.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; School of Medicine (A.R.-T.), University of California, Irvine; Department of Neurology (A.T.), Keck School of Medicine, University of Southern California, Los Angeles; Los Angeles County Department of Health Services (A.T.), CA; Stroke Program (L.S.), University of Michigan Medical School, Ann Arbor; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA.

Christina Kourkoulis (C)

From the Henry and Allison McCance Center for Brain Health (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., J.Q.A.H., C.D.A., J.R., A.B.), Department of Neurology (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., A.D.W., J.Q.A.H., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), and Center for Genomic Medicine (J.R.A., S.K., C.K., E.P.M., J.Q.A.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; School of Medicine (A.R.-T.), University of California, Irvine; Department of Neurology (A.T.), Keck School of Medicine, University of Southern California, Los Angeles; Los Angeles County Department of Health Services (A.T.), CA; Stroke Program (L.S.), University of Michigan Medical School, Ann Arbor; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA.

Axana Rodriguez-Torres (A)

From the Henry and Allison McCance Center for Brain Health (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., J.Q.A.H., C.D.A., J.R., A.B.), Department of Neurology (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., A.D.W., J.Q.A.H., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), and Center for Genomic Medicine (J.R.A., S.K., C.K., E.P.M., J.Q.A.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; School of Medicine (A.R.-T.), University of California, Irvine; Department of Neurology (A.T.), Keck School of Medicine, University of Southern California, Los Angeles; Los Angeles County Department of Health Services (A.T.), CA; Stroke Program (L.S.), University of Michigan Medical School, Ann Arbor; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA.

Evangelos Pavlos Myserlis (EP)

From the Henry and Allison McCance Center for Brain Health (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., J.Q.A.H., C.D.A., J.R., A.B.), Department of Neurology (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., A.D.W., J.Q.A.H., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), and Center for Genomic Medicine (J.R.A., S.K., C.K., E.P.M., J.Q.A.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; School of Medicine (A.R.-T.), University of California, Irvine; Department of Neurology (A.T.), Keck School of Medicine, University of Southern California, Los Angeles; Los Angeles County Department of Health Services (A.T.), CA; Stroke Program (L.S.), University of Michigan Medical School, Ann Arbor; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA.

Haitham Alabsi (H)

From the Henry and Allison McCance Center for Brain Health (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., J.Q.A.H., C.D.A., J.R., A.B.), Department of Neurology (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., A.D.W., J.Q.A.H., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), and Center for Genomic Medicine (J.R.A., S.K., C.K., E.P.M., J.Q.A.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; School of Medicine (A.R.-T.), University of California, Irvine; Department of Neurology (A.T.), Keck School of Medicine, University of Southern California, Los Angeles; Los Angeles County Department of Health Services (A.T.), CA; Stroke Program (L.S.), University of Michigan Medical School, Ann Arbor; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA.

Andrew D Warren (AD)

From the Henry and Allison McCance Center for Brain Health (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., J.Q.A.H., C.D.A., J.R., A.B.), Department of Neurology (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., A.D.W., J.Q.A.H., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), and Center for Genomic Medicine (J.R.A., S.K., C.K., E.P.M., J.Q.A.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; School of Medicine (A.R.-T.), University of California, Irvine; Department of Neurology (A.T.), Keck School of Medicine, University of Southern California, Los Angeles; Los Angeles County Department of Health Services (A.T.), CA; Stroke Program (L.S.), University of Michigan Medical School, Ann Arbor; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA.

Jonathan Q A Henry (JQA)

From the Henry and Allison McCance Center for Brain Health (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., J.Q.A.H., C.D.A., J.R., A.B.), Department of Neurology (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., A.D.W., J.Q.A.H., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), and Center for Genomic Medicine (J.R.A., S.K., C.K., E.P.M., J.Q.A.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; School of Medicine (A.R.-T.), University of California, Irvine; Department of Neurology (A.T.), Keck School of Medicine, University of Southern California, Los Angeles; Los Angeles County Department of Health Services (A.T.), CA; Stroke Program (L.S.), University of Michigan Medical School, Ann Arbor; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA.

M Edip Gurol (ME)

From the Henry and Allison McCance Center for Brain Health (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., J.Q.A.H., C.D.A., J.R., A.B.), Department of Neurology (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., A.D.W., J.Q.A.H., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), and Center for Genomic Medicine (J.R.A., S.K., C.K., E.P.M., J.Q.A.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; School of Medicine (A.R.-T.), University of California, Irvine; Department of Neurology (A.T.), Keck School of Medicine, University of Southern California, Los Angeles; Los Angeles County Department of Health Services (A.T.), CA; Stroke Program (L.S.), University of Michigan Medical School, Ann Arbor; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA.

Anand Viswanathan (A)

From the Henry and Allison McCance Center for Brain Health (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., J.Q.A.H., C.D.A., J.R., A.B.), Department of Neurology (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., A.D.W., J.Q.A.H., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), and Center for Genomic Medicine (J.R.A., S.K., C.K., E.P.M., J.Q.A.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; School of Medicine (A.R.-T.), University of California, Irvine; Department of Neurology (A.T.), Keck School of Medicine, University of Southern California, Los Angeles; Los Angeles County Department of Health Services (A.T.), CA; Stroke Program (L.S.), University of Michigan Medical School, Ann Arbor; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA.

Steven M Greenberg (SM)

From the Henry and Allison McCance Center for Brain Health (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., J.Q.A.H., C.D.A., J.R., A.B.), Department of Neurology (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., A.D.W., J.Q.A.H., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), and Center for Genomic Medicine (J.R.A., S.K., C.K., E.P.M., J.Q.A.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; School of Medicine (A.R.-T.), University of California, Irvine; Department of Neurology (A.T.), Keck School of Medicine, University of Southern California, Los Angeles; Los Angeles County Department of Health Services (A.T.), CA; Stroke Program (L.S.), University of Michigan Medical School, Ann Arbor; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA.

Amytis Towfighi (A)

From the Henry and Allison McCance Center for Brain Health (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., J.Q.A.H., C.D.A., J.R., A.B.), Department of Neurology (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., A.D.W., J.Q.A.H., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), and Center for Genomic Medicine (J.R.A., S.K., C.K., E.P.M., J.Q.A.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; School of Medicine (A.R.-T.), University of California, Irvine; Department of Neurology (A.T.), Keck School of Medicine, University of Southern California, Los Angeles; Los Angeles County Department of Health Services (A.T.), CA; Stroke Program (L.S.), University of Michigan Medical School, Ann Arbor; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA.

Lesli Skolarus (L)

From the Henry and Allison McCance Center for Brain Health (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., J.Q.A.H., C.D.A., J.R., A.B.), Department of Neurology (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., A.D.W., J.Q.A.H., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), and Center for Genomic Medicine (J.R.A., S.K., C.K., E.P.M., J.Q.A.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; School of Medicine (A.R.-T.), University of California, Irvine; Department of Neurology (A.T.), Keck School of Medicine, University of Southern California, Los Angeles; Los Angeles County Department of Health Services (A.T.), CA; Stroke Program (L.S.), University of Michigan Medical School, Ann Arbor; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA.

Christopher D Anderson (CD)

From the Henry and Allison McCance Center for Brain Health (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., J.Q.A.H., C.D.A., J.R., A.B.), Department of Neurology (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., A.D.W., J.Q.A.H., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), and Center for Genomic Medicine (J.R.A., S.K., C.K., E.P.M., J.Q.A.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; School of Medicine (A.R.-T.), University of California, Irvine; Department of Neurology (A.T.), Keck School of Medicine, University of Southern California, Los Angeles; Los Angeles County Department of Health Services (A.T.), CA; Stroke Program (L.S.), University of Michigan Medical School, Ann Arbor; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA.

Jonathan Rosand (J)

From the Henry and Allison McCance Center for Brain Health (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., J.Q.A.H., C.D.A., J.R., A.B.), Department of Neurology (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., A.D.W., J.Q.A.H., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), and Center for Genomic Medicine (J.R.A., S.K., C.K., E.P.M., J.Q.A.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; School of Medicine (A.R.-T.), University of California, Irvine; Department of Neurology (A.T.), Keck School of Medicine, University of Southern California, Los Angeles; Los Angeles County Department of Health Services (A.T.), CA; Stroke Program (L.S.), University of Michigan Medical School, Ann Arbor; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA.

Alessandro Biffi (A)

From the Henry and Allison McCance Center for Brain Health (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., J.Q.A.H., C.D.A., J.R., A.B.), Department of Neurology (J.R.A., J.P.C., S.K., C.K., E.P.M., H.A., A.D.W., J.Q.A.H., M.E.G., A.V., S.M.G., C.D.A., J.R., A.B.), and Center for Genomic Medicine (J.R.A., S.K., C.K., E.P.M., J.Q.A.H., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; School of Medicine (A.R.-T.), University of California, Irvine; Department of Neurology (A.T.), Keck School of Medicine, University of Southern California, Los Angeles; Los Angeles County Department of Health Services (A.T.), CA; Stroke Program (L.S.), University of Michigan Medical School, Ann Arbor; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA. abiffi@mgh.harvard.edu.

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Classifications MeSH

questionsmedicales.fr › Personnes › Nord-Américains › Groupes de population aux États-Unis › Populations d'origine continentale › Noir ou Africain Américain › Biological and Social Determinants of...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Biological and Social Determinants of...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Hémorragie › Hémorragies intracrâniennes › Hémorragie cérébrale › Biological and Social Determinants of...
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