Clinical analysis of factors predisposing the recurrence of primary intracerebral hemorrhage in patients taking anti-hypertensive drugs: A prospective cohort study

Objective: The study examined differences in the recurrence rate of primary intracerebral hemorrhage (P-ICH) according to anti-hypertensive drug (AHD) use by patients with hypertension. Methods: This prospective, longitudinal cohort study was performed on 2384 patients diagnosed with supratentorial P-ICH and hypertension in the stroke unit of a single-center. During follow-up (mean, 44.9 ± 31.5 months), investigators interviewed subjects or caregivers by telephone or examined patients every 3-6 months. Target blood pressure was <140/90 mmHg in the P-ICH cohort with hypertension. Results: Of 1317 P-ICH patients defined to be taking AHDs, P-ICH recurrence occurred in 129 (9.8%). 1211 patients (92.0%) reached target blood pressure. In multivariate regression analysis, advanced age (≥70 years), poor functional outcome after first P-ICH, lobar location of P-ICH, previous history of cerebral ischemia, diuretic monotherapy and α- or β-blocker monotherapy were associated with risk of recurrence. Conclusions: Although hypertension is the most important factor for preventing P-ICH recurrence, we found that, even in the presence of optimal anti-hypertensive medication, recurrent P-ICH attack can occur. Therefore, management of other risk factors of recurrent P-ICH, such as modification of lifestyle, must be considered in treating the P-ICH patients.