Intracerebral Hemorrhage, Racial Disparities, and Access to Care
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Article, see p 1444
Although it makes up only 15% to 20% of all strokes, intracerebral hemorrhage (ICH) is a particularly lethal form of this potentially disabling condition. A recent meta-analysis of 122 studies concluded that 1-year survival after ICH was 46% and 5-year survival was only 29%.1 Furthermore, quality of life for survivors is often limited.2 A thorough understanding of how to prevent these events is therefore a high priority.
In this issue of Circulation, Walsh and colleagues3 shed light on several important findings that suggest where attention should be directed to prevent these types of strokes. High blood pressure has long been associated with both ischemic and hemorrhagic strokes, and this study, including 958 white, 880 black, and 766 Hispanic ICH cases and the same number of age- and sex-matched controls, confirmed this strong association overall and by location of the stroke. Two main findings relate to blood pressure. First, high blood pressure was associated with ICH for all ethnicities, and second, this study also showed the large role of untreated high blood pressure on the risk for ICH.
The finding of higher risk with a history of treated blood pressure is difficult to interpret without blood pressure levels, one of this study’s acknowledged limitations. However, we can use published data suggesting that nationally only ≈60% of treated hypertensive patients achieve control, which surmises that at least some of the excess risk associated with treated hypertension stems from lack of control despite treatment.4 In fact, prior studies suggest that nationally …