Prevalence of Hypertension in Patients with Nontraumatic Intracranial Hemorrhage

Approximately 37-43% of patients with nontraumatic intracranial hemorrhage have a history of hypertension. 1, 2

Epidemiological Evidence

Hypertension is the leading cause of nontraumatic intracerebral hemorrhage (ICH) in young adults, accounting for 37% of cases in a comprehensive stroke center study 2
In an earlier municipal emergency hospital study, hypertension was found to be a related condition in 43% of patients with parenchymal hematomas 1
The majority of patients with malignant hypertension who present with hypertensive emergencies have unrecognized or uncontrolled essential hypertension 3

Deep hemorrhages in hypertensive patients are often due to hypertension, whereas lobar hemorrhages in nonhypertensive elderly patients are frequently due to cerebral amyloid angiopathy 3
Of putaminal hemorrhages specifically, 60% resulted from arterial hypertension in young adults with nontraumatic ICH 4
A substantial number of lobar hemorrhages in hypertensive patients may also be due to hypertension 3

Elevated systolic blood pressure >160 mmHg on admission has been associated with growth of the hematoma in retrospective studies, though this has not been demonstrated in prospective studies 3
Hypertension is a modifiable risk factor, making it a critical target for prevention of nontraumatic ICH 2
Limited access to healthcare and non-adherence to antihypertensive medications frequently contribute to the development of hypertensive emergencies 3

The volume of ICH and Glasgow Coma Scale (GCS) score on admission are the most powerful predictors of 30-day mortality, rather than hypertension status alone 3
Aggressive management of hypertension is essential to halt the increasing trends of ICH due to hypertension, particularly in young adults 2
Secondary causes of hypertension can be found in 20-40% of patients presenting with malignant hypertension, most often consisting of renal parenchymal disease and renal artery stenosis 3

When evaluating patients with nontraumatic ICH, clinicians should question about hypertension, prior ischemic stroke, diabetes mellitus, smoking, alcohol use, and use of medications that may predispose to bleeding 3
CT and MRI show equal ability to identify the presence of acute ICH, but the underlying cause (hypertensive vs. other etiologies) often requires additional clinical correlation 3
Both deep and superficial hemorrhages may be caused by vascular abnormalities and other nonhypertensive causes, necessitating thorough evaluation beyond simply assuming hypertension as the cause 3

Lobar location of ICH increases the risk of long-term recurrence by a factor of 3.8, regardless of hypertension status 3
In young adults with nontraumatic ICH, higher ICH scores were associated with worse outcomes, while the etiology of hemorrhage (hypertensive vs. other causes) was not associated with discharge outcome 2