Hypertension and the risk of intracerebral haemorrhage: special considerations in patients with renal disease

Intracerebral haemorrhage (ICH) comprises about 10-15% of strokes and is as sociated with a high mortality rate and a high level of persistent disabili ty in survivors [1,2]. Because there is little potential to ameliorate the damage after ICH has occurred, prevention is of particular importance. There is now quite clear evidence that hypertension is the most powerful ri sk factor for ICH. In a recent case-control study that involved 331 cases o f primary ICH and the same number of matched controls, the adjusted odds ra tio (OR) for ICH among hypertensives was 2.45 (95% confidence interval (CI) 1.61-3.73) [3]. A similar OR was obtained when patients who had ever used antihypertensive medication were considered (OR 2.44, 95% CI 1.56-3.82). Al though these ORs are generally less than those reported in most previous st udies of the condition [4-9] they are similar to the only other major Austr alian study [10]. The relatively low ORs might partly be explained by the h igh level of detection and management of hypertension in Australia, as well as other population differences, including the prevalence of smoking and o ther risk factors for ICH [11].