BP control and IPH recurrence 

N=1145
Study type: semi-prospective cohort.
Years: 1994-2011

Inclusion criteria:
- Age > 18
- Supratentorial IPH
- Alive after 90 days

Exclusion criteria:
- IPH from vascular malformation/aneurysm, tumor, trauma, or hemorrhagic transformation of ischemic stroke

Methodology:
- Study was separated into lobar and non-lobar IPH
- Follow up was conducted at 3, 6, 9, 12 mos and every 6 mos thereafter - inquiring about death, evidence of ICH recurrence, recorded BPs, medications.

Outcome:
- Recurrence of IPH

Results
- Overall recurrence rate of lobar IPH was ~20% and of non-lobar was ~7%

Comment:
- In multivariate regression, use of antiplatelet assoc with significant increased risk of ICH; warfarin - trending - likely underpowered - but big hazard ratio
- In nonlobar ICH - the relationships between drugs and recurrent ICH is less clear - both in magnitude and in statistical significance. This might have to do with statistical power, as non-lobar was much less common.

Comment:
In case you've forgotten your JNC 7 guidelines
- Normotension: SBP <120 and DBP <80
- Prehypertension: SBP 120-140 or DBP 80-90
- Stage 1: SBP 140-160 or DBP 90-100
- Stage 2: SBP >160 or DBP > 100
note that normotension carries an "and" operator for SBP and DBP whereas the others carry an "or" operator

This is an incredible dose-response relationship between even mild HTN (ie >120) and recurrence; HR for just a SBP of 120-140 was 2.8 in lobar and 3.0 in non-lobar. Man.

JNC 8 recommended SBP goal of <150 (elevated from <140) in older adults (>60) without DM or CKD; the idea is that if you are too aggressive with your goal, you overshoot too low and old people have falls and leads to worse outcomes.
But perhaps in older adults with a history of IPH, we should be more aggressive...