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

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PROJECT SUMMARY 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, the result of progression of underlying Cerebral Small Vessel Disease (CSVD), is accelerated for Black and Hispanic ICH survivors, yielding a substantial health disparity. Arresting this progression therefore holds the promise of markedly improving outcomes for the >50,000 ICH survivors annually in the US and correcting a considerable health inequity. 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, with substantially higher rates among Black and Hispanic patients. 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. Social determinants of health (SDOH), the wider set of forces and systems shaping daily life, contribute to risk for most medical conditions, and are key contributors to race/ethnic health inequities. Nonetheless, there have been no systematic studies of SDOH in ICH, leaving a crucial gap in knowledge. The overarching goal of the present renewal proposal, entitled Race / Ethnicity, Hypertension and Prevention of VCID and Stroke after ICH, is to build on the results of the soon-to-conclude Recurrent Hemorrhagic Stroke in Minority Populations (R01NS093870) study and fill gaps in the knowledge that is essential for informing the design of future interventions to enhance BP control and eliminate racial/ethnic inequities in 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 divided among Black, Hispanic, White, Asian individuals, all of whom will receive a standardized state-of-the-art evidence-based program of BP management. We seek to: 1) determine whether modifiable SDOH in association with established biological factors, predict increased risk for VCID and recurrent stroke after ICH; 2) determine whether modifiable SDOH predict risk of poor hypertension control after ICH; 3) determine whether modifiable SDOH 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.