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Comment & Response |

Blood Pressure Control and Recurrence of Intracerebral Hemorrhage—Reply

Alessandro Biffi, MD1; Jonathan Rosand, MD, MSc1
[+] Author Affiliations
1Department of Neurology, Massachusetts General Hospital, Boston
JAMA. 2016;315(6):611-612. doi:10.1001/jama.2015.16017.
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In Reply Dr Vidale and colleagues point out that different ICH etiopathogenetic mechanisms (ie, arteriolosclerosis vs CAA) confer different risks for ICH recurrence. We previously reported that lobar ICH (related to underlying CAA) was associated with higher risk of recurrence than nonlobar ICH.1 These findings were confirmed in our most recent study, in which we reported a recurrence rate of 7.8% per year for lobar ICH vs 3.2% per year for nonlobar ICH (P < .001). Based on the CAA classification scheme provided by the Boston Criteria,2 among 505 cases of lobar ICH, we diagnosed 19 definite CAA cases (3.7%), 265 probable CAA cases (52.5%), and 221 possible CAA cases (43.8%). We observed an association between inadequate BP control and risk of recurrent lobar ICH in the definite or probable CAA group (hazard ratio [HR], 2.98 [95% CI, 1.09-8.17]) and the possible CAA group (HR, 3.23 [95% CI, 1.09-9.54]).


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February 9, 2016
Simone Vidale, MD; Claudio Pini, MD; Marco Arnaboldi, MD
1Department of Neurology and Stroke Unit, Sant’Anna Hospital, Como, Italy
2Hypertension Centre, Sant’Anna Hospital, Como, Italy
JAMA. 2016;315(6):611. doi:10.1001/jama.2015.16011.
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