From the Department of Epidemiology and Preventive Medicine, Monash
Medical School, Alfred Hospital, Prahran (A.G.T., J.J.M., A.F.), and the
Department of Neurology, Austin and Repatriation Medical Centre, Heidelberg
(G.A.D.), Victoria, Australia.
Abstract—Hypertension as a risk
factor for intracerebral hemorrhage (ICH) is
poorly quantified, particularly in the setting of the use of modern
antihypertensive agents. To investigate this, we studied 331
consecutive hospital cases of primary ICH verified by computed
tomography or autopsy, occurring during the period 1990 through 1992,
and 331 age- and sex-matched community-based control subjects in a
city-wide study involving 13 hospitals. Hypertension approximately
doubled the risk of ICH (adjusted odds ratio [OR], 2.45; 95%
confidence interval [CI], 1.61 to 3.73). The OR associated with
hypertension was significantly greater among those who had ceased
taking medications, supervised and unsupervised (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 or location of the
hemorrhage. However, those dying from ICH displayed a greater
risk of ICH due to hypertension than survivors, with the ratio of the
two ORs being 5.47 (95% CI, 1.23 to 24.44). These findings provide
evidence for a greater increase in risk of ICH due to hypertension
among younger persons, current smokers, and those discontinuing
antihypertensive therapy. This is the first direct evidence for a link
between stopping antihypertensive medication use and stroke risk;
targeting these individuals for more intensive monitoring and education
on the importance of risk factor modification may help to reduce the
impact of this form of stroke.
© 1998 American Heart Association, Inc.
Scientific Contributions
Three Important Subgroups of Hypertensive Persons at Greater Risk of Intracerebral Hemorrhage
Key Words: cerebral hemorrhage • epidemiology • risk factors • case-control studies • age • smoking
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