Race/ethnicity and response to blood pressure lowering treatment after intracerebral hemorrhage

Mohammad Anadani; Adnan I Qureshi; Sarah Menacho; Ramesh Grandhi; Shadi Yaghi; Mouhammad A Jumaa; Adam de Havenon

doi:10.1177/23969873211046116

Race/ethnicity and response to blood pressure lowering treatment after intracerebral hemorrhage

Eur Stroke J. 2021 Dec;6(4):343-348. doi: 10.1177/23969873211046116. Epub 2021 Sep 21.

Authors

Mohammad Anadani¹, Adnan I Qureshi², Sarah Menacho³, Ramesh Grandhi³, Shadi Yaghi⁴, Mouhammad A Jumaa⁵, Adam de Havenon⁶

Affiliations

¹ Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA.
² Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA.
³ Department of Neurosurgery, University of Utah, Salt Lake, UT, USA.
⁴ Department of Neurology, New York University, New York, NY, USA.
⁵ Department of Neurology, University of Toledo, Toledo, OH, USA.
⁶ Department of Neurology, University of Utah, Salt Lake, UT, USA.

Abstract

Background: It is unknown if race/ethnicity modifies the response to blood pressure (BP) lowering treatment after intracerebral hemorrhage (ICH). We aimed to examine the race/ethnicity differences in the response to BP lowering treatment after ICH.

Methods: This is a post hoc analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2) trial. The primary outcome is good outcome, defined as 90-day modified Rankin Scale 0-3. The primary predictor is race/ethnicity for which we included non-Hispanic categories of White, Black, Asian, and the category of Hispanic. We fit adjusted logistic regression models with the predictor of race/ethnicity and models with the interaction term of treatment*race/ethnicity.

Results: We included a total of 953 patients in our analysis (White = 213, Black = 112, Asian = 554, and Hispanic = 74). In the models with the interaction between race/ethnicity and treatment, we found that White patients assigned to the intensive treatment arm had lower predicted probability of good outcome than those assigned to the standard treatment arm (Model 1: 56.2% vs. 68.1%, p = .027; Model 2: 53.4% vs. 68.3%, p = .009). When divided into White and non-White groups, intensive treatment was associated with higher odds of serious adverse events in White group but not in the non-White group. In addition, there was an association between intensive treatment and higher risk of hematoma expansion in White patients and lower risk of hematoma expansion in non-White patients.

Conclusions: In the ATACH-2, there was an interaction between race/ethnicity and response to BP lowering treatment after ICH, with White patients having an association between intensive blood pressure reduction and worse outcome.

Keywords: Stroke; blood pressure; hemorrhage; race.