Background and aims: Evidence of regional differences in neurological deterioration and other clinical outcomes after intracerebral hemorrhage (ICH) is still scarce.
Methods: Post-hoc analysis of the Blood pressure in Acute Stroke Collaboration (BASC) ICH dataset. Generalized linear mixed models with inverse probability of treatment weighting (IPTW) were used to determine the association between regions (Asian vs. non-Aisan) and clinical outcomes (neurological deterioration at 7 days, hematoma expansion at 24 hours, and functional recovery according to modified Rankin Scale and any serious adverse events at 90-day) compared to non-Asians with adjustment of trial sources. The interaction between region and randomized blood pressure treatment (active/intensive vs. placebo/guideline) was explored across the clinical outcomes.
Results: Among 6221 patients included, 56.2% were from Asia. Asians were younger, had greater severity, more likely to have history of hypertension and stroke but less likely to have lobar or intraventricular hemorrhage compared to non-Asians. Asians had significantly reduced risk of neurological deterioration (adjusted OR [aOR] 0.70, 95% Confidence Interval [CI] 0.56-0.89), death or dependency (0.72, 0.63-0.83), major disability (0.72, 0.62-0.83) and any serious adverse events (0.58, 0.49-0.69), in comparison to non-Asians. However, there was no differences found on haematoma expansion at 24 hrs or death at 90 days. There was no significant interactions between BP lowing treatment and region across all the clinical outcomes.
Conclusions: Patients from Asia had lower risk of neurological deterioration and poor outcomes compare to non-Asians, but no differences in haematoma expansion at 24 hrs after ICH.