Race / Ethncicity, Hypertension and Prevention of VCID and Stroke after Intracerebral Hemmorrhage

Intracerebral hemorrhage (ICH) accounts for almost half of stroke-related morbidity and mortality. Among ICH survivors, nearly 2/3 will develop either incident cognitive decline, in the form of Vascular contributions to Cognitive Impairment and Dementia (VCID), or recurrent stroke within 5 years. This rapid functional decline is the result of progression of underlying Cerebral Small Vessel Disease (CSVD). Arresting this progression therefore holds the promise of markedly improving outcomes for the >50,000 ICH survivors annually in the US. Elevated Blood Pressure (BP) is the most potent predictor of incident VCID and stroke after ICH. Yet >50% of ICH survivors have untreated hypertension after their ICH. Improving BP control following stroke remains a persistent challenge. Clinical trials of BP lowering programs have not demonstrated efficacy. A chief obstacle has been a failure to engage patients in the programs. Non-Medical Drivers of Health (NMOH), the wider set of forces and systems shaping daily life, contribute to risk for most medical conditions. Nonetheless, there have been no systematic studies of NMOH in ICH, leaving a crucial gap in knowledge. The overarching goal of the present renewal proposal, entitled Non-Medical Drivers of Health, Hypertension and Prevention of VCID and Stroke after ICH, is to build on the results of our prior work and fill gaps in the knowledge that is essential for informing the design of future interventions to enhance BP control and substantially reduce rates of VCID and recurrent stroke after ICH. The crucial next step is identifying potentially modifiable SDOH that have the highest impact on 1) post-ICH VCID and recurrent stroke; 2) rates of uncontrolled hypertension, and 3) engagement with strategies to lower BP. We will enroll and follow longitudinally 700 ICH survivors, all of whom will receive a standardized state-of-the-art evidence-based program of BP management. We seek to: 1) determine whether modifiable NMOH in association with established biological factors, predict increased risk for VCID and recurrent stroke after ICH; 2) determine whether modifiable NMOH predict risk of poor hypertension control after ICH; 3) determine whether modifiable NMOH are associated with decreased engagement with our standardized BP management program. The data generated will be used to develop novel strategies for BP management and prevention of VCID and recurrent stroke after ICH and are likely to have implications for preventing CSVD-related VCID and stroke, even in those who have not suffered an ICH.