3 IMPORTANT SUBGROUPS OF HYPERTENSIVE PERSONS AT GREATER RISK OF INTRACEREBRAL HEMORRHAGE

Hypertension as a risk factor for intracerebral hemorrhage (ICH) is po orly quantified, particularly in the setting of the use of modern anti hypertensive agents. To investigate this, we studied 331 consecutive h ospital cases of primary ICH verified by computed tomography or autops y, occurring during the period 1990 through 1992, and 331 age-and sex- matched community-based control subjects in a city-wide study involvin g 13 hospitals. Hypertension approximately doubled the risk of ICH (ad justed odds ratio [OR], 2.45; 95% confidence interval [CI], 1.61 to 3. 73). The OR associated with hypertension was significantly greater amo ng those who had ceased taking medications, supervised and unsupervise d (OR, 4.98; 95% CI, 2.25 to 11.02), compared with those who had not ( OR, 1.95; 95% CI, 1.20 to 3.16), were under the age of 55 years (OR, 7 .68; 95% CI, 2.65 to 22.5), or were current smokers (OR, 6.12; 95% CI, 2.29 to 16.35). The presence of hypertension did not influence size o r location of the hemorrhage. However, those dying from ICH displayed a greater risk of ICH due to hypertension than survivors, with the rat io of the two ORs being 5.47 (95% CI, 1.23 to 24.44). These findings p rovide evidence for a greater increase in risk of ICH due to hypertens ion among younger persons, current smokers, and those discontinuing an tihypertensive therapy. This is the first direct evidence for a link b etween stopping antihypertensive medication use and stroke risk; targe ting these individuals for more intensive monitoring and education on the importance of risk factor modification may help to reduce the impa ct of this form of stroke.