Abstract
Objectives:
Elevated blood pressure (BP) in ICH often requires urgent treatment. Prior studies have shown racial-ethnic differences in response to chronic antihypertensive treatment. Racial-ethnic differences and specific locations of ICH may impact the response to acute antihypertensive treatment (aHTN) in ICH. The aim of this study was to analyze variation of response to aHTN drugs by race-ethnicity and location of ICH.
Methods:
We included individuals recruited through the Ethnic/Racial Variations of Intracerebral Hemorrhage study with elevated BP on presentation and received labetalol, nicardipine, or hydralazine as the initial aHTN or who received no treatment despite elevated BP. We excluded individuals treated with multiple aHTN, treated with other aHTN, or lacking documentation of dose. The primary outcome measure was mmHg change in BP per 10 mg of drug administered. Changes in BP were tested using the Wilcoxon rank sum test.
Results:
A total of 1153 cases were available for analyses (35% white, 34% black, 31% Hispanic). Blacks were most likely to be treated acutely (52%), followed by Hispanics and whites (41%; 34%; p<0.01). For all three aHTN drugs, no significant racial-ethnic difference in systolic (SBP) or diastolic (DBP) response was found (p=0.92 for SBP; p=0.17 for DBP). Neither SBP nor DBP response differed by drug for lobar (p=0.36 SBP; p=0.25 DBP), deep (p=0.99 SBP; p=0.29 DBP) or posterior fossa (p=0.26 SBP, p=0.11 DBP) locations.
Conclusion:
In this large, multiethnic study of ICH, we are unable to detect a difference in BP response to hydralazine, labetalol, and nicardipine across race-ethnicity or locations of ICH. This finding suggests that the most commonly used aHTN agents in ICH regimens do not need to be tailored to ethnicity or ICH location. A larger cohort may provide greater power to detect a smaller difference between the agents.