Abstract Details

Title Cerebral Small Vessel Disease Subtypes and Blood Pressure Control after Intracerebral Hemorrhage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 6-024

Objective NA

Background

Intracerebral hemorrhage (ICH) survivors are at high risk of neurological decline for underlying progressive cerebral small vessel disease (CSVD). Most ICHs are attributable to two common CSVD types: cerebral amyloid angiopathy (CAA) and hypertensive-CSVD (HTN-CSVD). HTN-CSVD includes pure deep or mixed location ICH/microbleeds, the latter more severe. Hypertension control being the most potent intervention delaying CSVD-related ICH progression, we investigated whether more severe forms of HTN-CSVD are related to worse blood pressure (BP) control over time after CSVD-related ICH.

Design/Methods

We analyzed data from consecutive non-traumatic ICH in-patients between 2011-2020 in a tertiary care center. MRI-based CSVD markers classified ICH patients as CAA-related and HTN-CSVD-related, deep and mixed locations within HTN-CSVD. Validated MRI-based score quantified CSVD burden. Longitudinal BP following ICH obtained via semi-automated electronic health records review. Linear mixed effects models examined association of BP during follow-up with CSVD etiology and severity.

Results

796 ICH survivors were followed for a median of 48.8 months (interquartile range [IQR] 41.5 - 60.4). CAA-related (n = 373) displayed lower systolic BP (median 138 mmHg, IQR: 133-142 mmHg) compared to deep hypertensive ICH/microbleeds (n = 222, systolic BP median 141 mmHg, IQR: 136-143 mmHg, p = 0.037 for comparison), and mixed location ICH/microbleeds (n = 201, systolic BP median 142 mmHg, IQR: 135-144 mmHg, p = 0.015 for comparison). In multivariable analysis, mixed location ICH/microbleeds (effect: +3.8 mmHg, Standard Error [SE]: 1.3 mmHg, p = 0.008) and increasing CSVD severity (+1.8 mmHg per score point, SE: 0.8 mmHg, p = 0.032) were independently associated with higher follow-up systolic BP. No associations between CSVD subtype/severity and diastolic BP.

Conclusions

CSVD severity and subtype predict subsequent hypertension control. We confirm previous findings that mixed location ICH/microbleeds are related to more severe hypertensive disorder. Our findings support incorporating MRI-derived CSVD markers when tailoring hypertension control strategies for ICH survivors.

Authors/Disclosures
Akashleena Mallick, MD, MBBS (Massachusetts General Hospital- Harvard Medical School) PRESENTER	Dr. Mallick has nothing to disclose.
Alvin Das, MD	Dr. Das has nothing to disclose.
	No disclosure on file
	No disclosure on file
Juan Pablo Castello, MD	No disclosure on file
Marco Pasi	No disclosure on file
Dominique Popescu, PhD (Massachusetts General Brigham)	Dr. Popescu has nothing to disclose.
Leidys Gutierrez-Martinez, MD (Massachusetts General Hospital)	The institution of Dr. Gutierrez-Martinez has received research support from American Heart Association.
Ernst Mayerhofer, MD	Dr. Mayerhofer has nothing to disclose.
Christina Kourkoulis	No disclosure on file
	No disclosure on file
	No disclosure on file
Elif Gokcal	Elif Gokcal has nothing to disclose.
Anand Viswanathan, MD (Massachusetts General Hospital)	Dr. Viswanathan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alnylam Pharmaceuticals. Dr. Viswanathan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Viswanathan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche Pharmaceuticals.
Steven M. Greenberg, MD, PhD, FAAN	Dr. Greenberg has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer. Dr. Greenberg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Myers Squib. The institution of Dr. Greenberg has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alnylam. Dr. Greenberg has received research support from National Institutes of Health. Dr. Greenberg has received publishing royalties from a publication relating to health care.
Christopher D. Anderson, MD, PhD, FAAN (Brigham and Women's Hospital)	The institution of Dr. Anderson has received research support from Bayer AG. The institution of Dr. Anderson has received research support from American Heart Association. The institution of Dr. Anderson has received research support from National Institutes of Health. An immediate family member of Dr. Anderson has received publishing royalties from a publication relating to health care.
Jonathan Rosand, MD (Massachusetts General Hospital)	Dr. Rosand has received personal compensation for serving as an employee of Massachusetts General Hospital. Dr. Rosand has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly and Co. Dr. Rosand has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. The institution of Dr. Rosand has received research support from NIH. The institution of Dr. Rosand has received research support from American Heart Association. Dr. Rosand has received personal compensation in the range of $0-$499 for serving as a Peer reviewer with National Institutes of Health. Dr. Rosand has a non-compensated relationship as a Trustee with Columbia University that is relevant to AAN interests or activities.
Edip M. Gurol, MD (Massachusetts General Hospital)	The institution of Dr. Gurol has received research support from NIH/NINDS. The institution of Dr. Gurol has received research support from Boston Scientific Corporation. The institution of Dr. Gurol has received research support from AVID (a wholly owned subsidiary of Eli Lilly). The institution of Dr. Gurol has received research support from Pfizer.
Alessandro Biffi, MD (Eli Lilly and Company)	Dr. Biffi has received personal compensation for serving as an employee of Eli Lilly And Company. Dr. Biffi has stock in Eli Lilly And Company.

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