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Comment & Response
February 9, 2016

Blood Pressure Control and Recurrence of Intracerebral Hemorrhage—Reply

Author Affiliations
  • 1Department of Neurology, Massachusetts General Hospital, Boston

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2016;315(6):611-612. doi:10.1001/jama.2015.16017

In Reply Dr Vidale and colleagues point out that different ICH etiopathogenetic mechanisms (ie, arteriolosclerosis vs CAA) confer different risks for ICH recurrence. We previously reported that lobar ICH (related to underlying CAA) was associated with higher risk of recurrence than nonlobar ICH.1 These findings were confirmed in our most recent study, in which we reported a recurrence rate of 7.8% per year for lobar ICH vs 3.2% per year for nonlobar ICH (P < .001). Based on the CAA classification scheme provided by the Boston Criteria,2 among 505 cases of lobar ICH, we diagnosed 19 definite CAA cases (3.7%), 265 probable CAA cases (52.5%), and 221 possible CAA cases (43.8%). We observed an association between inadequate BP control and risk of recurrent lobar ICH in the definite or probable CAA group (hazard ratio [HR], 2.98 [95% CI, 1.09-8.17]) and the possible CAA group (HR, 3.23 [95% CI, 1.09-9.54]).