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Racial-ethnic disparities in acute blood pressure after intracerebral hemorrhage

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journal contribution
posted on 20.08.2017, 00:00 by Koch S, Elkind MS, Testai FD, Brown WM, Martini S, Sheth KN, Chong JY, Osborne J, Moomaw CJ, Langefeld CD, Sacco RL, Woo D, ERICH Study Investigators
OBJECTIVE: To assess race-ethnic differences in acute blood pressure (BP) following intracerebral hemorrhage (ICH) and the contribution to disparities in ICH outcome. METHODS: BPs in the field (emergency medical services [EMS]), emergency department (ED), and at 24 hours were compared and adjusted for group differences between non-Hispanic black (black), non-Hispanic white (white), and Hispanic participants in the Ethnic Racial Variations of Intracerebral Hemorrhage case-control study. Outcome was obtained by modified Rankin Scale (mRS) score at 3 months. We analyzed race-ethnic differences in good outcome (mRS ≤ 2) and mortality after adjusting for baseline differences and included BP recordings in this model. RESULTS: Of 2,069 ICH cases enrolled, 30% were white, 37% black, and 33% Hispanic. Black and Hispanic patients had higher EMS and ED systolic and diastolic BPs compared with white patients (p = 0.0001). Although attenuated, at 24 hours after admission, black patients had higher systolic and diastolic BPs. After adjusting for baseline differences, significant race/ethnic differences persisted for EMS systolic, ED systolic and diastolic, and 24-hours diastolic BP. Only ED systolic and diastolic BP was associated with poor functional outcome, and no BP predicted mortality. We found no race-ethnic differences in 3-month functional outcome or mortality after adjusting for group differences, including acute BPs. CONCLUSIONS: Although black and Hispanic patients had higher BPs than white patients at presentation, we did not find race-ethnic disparities in 3-month functional outcome or mortality. ED systolic and diastolic BP was associated with poor functional outcome, but not mortality, in this race-ethnically diverse population.


This study was supported by a research grant from the National Institute of Neurological Disorders (ERICH: U01-NS069763).


Publisher Statement

This is a copy of an article published in Neurology. © 2016 American Academy of Neurology Publications. DOI:10.1212/WNL.0000000000002962


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