BACKGROUND/AIMS: Most intracerebral hemorrhage (ICH) survivors have uncontrolled hypertension, leading to elevated long-term cardiac and cerebrovascular risk. As many require ≥3 antihypertensive medications for blood pressure (BP) control after ICH, upfront triple antihypertensive medication would improve therapeutic inertia and consequent better BP control. However, excessive BP lowering with triple antihypertensives remains a concern, especially in older people. Hence, we aim to develop a prediction score (TRICH) to predict the need for ≥3 antihypertensives for BP control three months post-ICH.
METHODS: We developed the score from 495 patients from the Queen Mary Hospital ICH registry from 2011-2022 and validated it in three other hospitals in Hong Kong comprised of 203 patients admitted from 2020-2022. Outpatient BP and antihypertensive medication prescriptions three months post-ICH were reviewed. Predictors of the need for ≥3 antihypertensive agents were derived using multivariate logistic regression, and the TRICH score was created based on the β coefficients.
RESULTS: Age <60, males, estimated glomerular filtrate rate (eGFR)<60mL/min/1.73m2, and higher admission systolic BP were independently associated with the need for ≥3 antihypertensives three months post-ICH. The 4-point TRICH score (0.5 points for age <60, 0.5 for males, 1 for eGFR <60mL/min/1.73m2, 1 for admission systolic BP 190-240mmHg, and 2 for >240mmHg) has a c statistic of 0.74; 0.76 for the validation cohort. A dichotomized score (TRICH ≥1.5) predicted the need for ≥3 antihypertensive with 0.63 sensitivity and 0.75 specificity.
CONCLUSION: The TRICH score had good discrimination ability. Prospective studies can test the applicability of this score in clinical practice.