Clinico-radiological Characteristics and Outcomes of Spontaneous Intracerebral Hemorrhage in Patients With and Without Hypertension: A Study Comparing Spontaneous Hypertensive Versus Non-hypertensive Intracerebral Hemorrhage

Abstract

Objectives

A significant number of non-hypertensive individuals suffer from parenchymal bleeds at sites characteristic of hypertensive bleed. Some even present with a higher arrival blood pressure due to transient hypertensive response. We aimed to study the clinico-radiological characteristics and outcomes of spontaneous intracerebral hemorrhage (ICH) in patients with and without hypertension.

Materials and Methods

We performed a single-center prospective observational study. A total of 162 patients with spontaneous ICH were recruited over 2 years. Patients with a preceding history of hypertension, having positive hypertension biomarkers, or requiring antihypertensives on follow-up were classified as hypertensive ICH; otherwise, as non-hypertensive ICH. Clinico-radiological parameters and outcome comparisons were done between the two groups.

Results

Of 162 patients (mean age 53.1 ± 13.2, 64.2% men), 35 (21.6%) belonged to non-hypertensive ICH. Among these 35 patients, 16 (45.7%) had a transient hypertensive response. Among the hypertensive ICH group, 75 (59.05%) had a history of hypertension and were taking antihypertensive medication, but only 5 (6.7%) were continuing it at the time of the event. Mortality and modified Rankin scale (mRS) ≤2 at the end of 3 months were 12.3% and 52.5%, respectively. 90-day and 30-day mortality, as well as good outcomes based on mRS, did not differ significantly between the two groups. Maximum mortality occurred within 30 days post-ictus, and the rates significantly declined thereafter. Of 35 patients in the non-hypertensive ICH group, 22 (62.9%) remained cryptogenic.

Conclusion

Non-hypertensive ICH represents one-fifth of total spontaneous ICH with the majority being cryptogenic despite advanced technology and diverse causes accounting for the remainder. There was no outcome and mortality difference between hypertensive ICH and non-hypertensive ICH. Among hypertensive ICH, non-adherence to medication should be a point of concern for us.