BACKGROUND Hypoperfusion due to blood pressure (BP) reduction is a potential mechanism of cerebral ischemia after intracerebral hemorrhage. However, prior evaluations of the relationship between BP reduction and ischemia have been conflicting. Untreated chronic hypertension is common in intracerebral hemorrhage and alters cerebral autoregulation. We hypothesized that the risk of diffusion-weighted imaging (DWI) hyperintensities from acute BP reduction is modified by premorbid BP control. METHODS Individuals enrolled in the ERICH study (Ethnic/Racial Variations of Intracerebral Hemorrhage) from 2010 to 2015 were categorized as untreated, treated, or nonhypertensive based on preintracerebral hemorrhage diagnosis and antihypertensive medication use. The percent reduction of systolic BP (SBP) was calculated between presentation and 24 hours from admission. The primary outcome was the presence of DWI lesions. Using logistic regression, we tested the association between chronic hypertension status, SBP reduction, and their interaction with DWI lesion presence. RESULTS From 3000 participants, 877 with available magnetic resonance imaging met inclusion (mean age, 60.5±13.3 years; 42.5% women). DWI lesions were detected in 25.9%. Untreated, treated, and no hypertension accounted for 32.6%, 47.9%, and 19.5% of cases, respectively. SBP reduction was not directly associated with DWI lesions; however, an interaction effect was observed between SBP reduction and chronic hypertension status (P=0.036). Nonhypertensive subjects demonstrated a linear risk of DWI lesion presence with greater SBP reduction, whereas untreated hypertension demonstrated a stable risk across a wide range of SBP reduction (P=0.023). CONCLUSIONS Premorbid BP control, especially untreated hypertension, may influence the relationship between DWI lesions and acute BP reduction after intracerebral hemorrhage. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT01202864.

中文翻译：

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病前血压控制可通过脑出血急性血压降低来降低 DWI 病变的风险。


背景技术由于血压(BP)降低引起的低灌注是脑出血后脑缺血的潜在机制。然而，先前对血压降低和缺血之间关系的评估是相互矛盾的。未经治疗的慢性高血压在脑出血中很常见，并且会改变脑的自动调节。我们假设，急性血压降低导致弥散加权成像（DWI）高信号的风险可以通过病前血压控制来改变。方法 2010 年至 2015 年参加 ERICH 研究（脑出血的种族/种族变异）的个体根据脑出血前诊断和抗高血压药物使用情况分为未治疗、治疗或非高血压。计算就诊至入院 24 小时之间的收缩压 (SBP) 降低百分比。主要结果是 DWI 病变的存在。使用逻辑回归，我们测试了慢性高血压状态、SBP 降低及其与 DWI 病变存在的相互作用之间的关联。结果 在 3000 名参与者中，877 名具有可用磁共振成像的参与者被纳入（平均年龄，60.5±13.3 岁；42.5% 为女性）。 DWI 病变检出率为 25.9%。未治疗、已治疗和无高血压病例分别占 32.6%、47.9% 和 19.5%。 SBP 降低与 DWI 病变没有直接关系；然而，SBP 降低与慢性高血压状态之间存在交互作用（P=0.036）。非高血压受试者表现出 DWI 病变存在与 SBP 降低幅度较大的线性风险，而未经治疗的高血压受试者在 SBP 降低幅度较大的范围内表现出稳定的风险 (P=0.023)。 结论 病前血压控制，尤其是未经治疗的高血压，可能会影响 DWI 病变与脑出血后血压急性降低之间的关系。注册网址：https://www.clinicaltrials.gov；唯一标识符：NCT01202864。