Abstract 2267: Poor Long-Term Blood Pressure Control after Intracerebral Hemorrhage in a Predominantly African American Hypertensive Population

Objective: Hypertension is the most important risk factor for both primary and secondary prevention of intracerebral hemorrhage (ICH). We sought to determine the frequency of blood pressure control after ICH and explored predictors of higher blood pressure (BP) at presentation, 30 days, and 1 year in a prospective cohort study. Methods: Individuals with spontaneous non-traumatic ICH were prospectively enrolled in the DiffErenCes in the Imaging of Primary Hemorrhage based on Ethnicity or Race (DECIPHER) Project. BP was measured at 30 days and 1 year during in-person visits, and BP at presentation was abstracted from the medical record. Linear regression was used to determine factors associated with mean arterial pressure (MAP) at presentation, and longitudinal linear regression was used to determine baseline predictors of MAP at 30 days at 1 year. Results: A total of 143 patients had blood pressure data available at either 30 days (125 patients) or 1 year (85 patients). Mean age was 59, 57% were men, and 80% were African American (AA) and the rest were White (other race/ethnic groups excluded due to low numbers). AAs were younger (57 vs. 65, p=0.002), less likely to be married (37% vs. 61%, p=0.02), more likely to have a history of hypertension (90% vs. 71%, p=0.03), and more likely to be smokers (30% vs. 11%, p=0.03) than Whites. Average BP at presentation was 178±35/99±24mmHg. Multivariable linear regression revealed that AAs had a presenting MAP that was on average 14mmHg higher than Whites despite adjustment for age, gender, socioeconomic status, body mass index, private health insurance, marital status, smoking, cocaine, and ICH volume. Blood pressure control at follow-up was poor, with fewer than 20% of patients having a normal blood pressure ( Conclusions: AAs had a higher MAP than Whites at the time of presentation with ICH. Optimal blood pressure control at 1 year occurred in less than 20% of the cohort. The only factor predictive of lower MAP at follow up was being married at baseline. Additional efforts are urgently needed to improve blood pressure control in both AA and White ICH survivors.