Effect of Untreated

Hypertension on
Hemorrhagic Stroke
Mendoza, Camille Rae R.
BMLS IV A
ABSTRACT
 Stroke is the third leading cause of death and the leading
cause of disability in the United States.
 Intracerebral hemorrhage and subarachnoid hemorrhage
represent 20% of all stroke cases and have a mortality
rate of 40% to 50%.
 Hypertension-an important risk factor for these subtypes
of stroke.
 We sought to determine whether untreated hypertension
carries a different risk from treated hypertension for
hemorrhagic stroke.
INTRODUCTION
 Hemorrhagic stroke occurs in 71 000 to 77 000 persons
annually in the United States
 intracerebral hemorrhage (ICH)
 subarachnoid hemorrhage (SAH)
 hypertension
 significant and independent risk factor for ICH and SAH
INTRODUCTION
 Treatment of hypertension
 most important factor in reducing the incidence of stroke
and decreasing the risk of cardiovascular disease

 untreated
hypertension was a significant risk factor for
hemorrhagic stroke
METHODS
 Cases of hemorrhagic stroke in the greater Cincinnati
region were identified by screening all area hospital
emergency rooms, radiology reports, and International
Classification of Diseases 9 codes.
 Medical records were reviewed for risk factors and
medication use.
 Cases of hemorrhagic stroke were approached for
enrollment into the genetic sampling and interview arm.
 If subjects agreed, the case was matched by age, race, and
gender to population-based controls.
METHODS
 Cases are eligible for the study if they:
 18 years of age
 have a first-ever SAH or ICH
 reside within a 50-mile radius of the University of
Cincinnati
 have no evidence of trauma or brain tumor as the
cause of hemorrhage
RESULTS
 Between May 1997 and December 2002:
 recruited 549 cases of hemorrhagic stroke
 322 were intracerebral hemorrhage (ICH)
 227 were subarachnoid hemorrhage (SAH)

 Untreated hypertension was found to be a

significant risk factor for hemorrhagic stroke as
was treated hypertension
RESULTS
approximately one fourth of hemorrhagic strokes
would be prevented if all hypertensive subjects received
treatment

 Blackstended to have higher rates of hypertension

and untreated hypertension than nonblacks.
RESULTS
 potential risk factors for untreated hypertension:
 including race
 Gender
 education category
 socioeconomic class
 insurance status,
RESULTS
 insurance status of self-pay/Medicaid subjects
 significantly more common among untreated
hypertension patients than treated hypertension
patients

 women were more likely to have their hypertension

treated than men
RESULTS
 17% to 28% of hemorrhagic strokes among
hypertensive patients would have been prevented
if they had been on hypertension treatment.
 Hypertension, even if treated, was still a
significant risk factor for hemorrhagic stroke
CONCLUSION
 Untreated hypertension
 highly prevalent
 an important risk factor for hemorrhagic stroke.
 approximately one fourth of hemorrhagic strokes
would be prevented if all hypertensive subjects received
treatment
AUTHORS
 Daniel Woo, MD; Mary Haverbusch, RN; Padmini
Sekar, MS; Brett Kissela, MD; Jane Khoury, MS;
Alexander Schneider, MD; Dawn Kleindorfer,
MD; Jerzy Szaflarski, MD, PhD; Arthur Pancioli,
MD; Edward Jauch, MD; Charles Moomaw, PhD;
Laura Sauerbeck, RN;James Gebel, MD; Joseph
Broderick, MD