Black participants had 3.02 times higher odds and those with high socioeconomic deprivation 1.74 times higher odds of uncontrolled post-ICH BP compared to their counterparts.
Racial and socioeconomic disparities in post-ICH blood pressure control are significantly mediated by pre-ICH blood pressure control, emphasizing the need for improved upstream hypertension management.
Background: Blood pressure (BP) control is a crucial component of secondary prevention after intracerebral hemorrhage (ICH), yet long-term control often remains suboptimal, particularly among racial minorities and socioeconomically disadvantaged populations. We compared the relationship between pre- and post-ICH BP control across racial/ethnic and social deprivation groups in the U.S. Methods: We conducted a case-only study within All of Us, an NIH population study aiming to enroll 1 million Americans. We used SNOMED codes to identify ICH survivors from electronic health records. Systolic BP measurements from EHR and baseline study visits were classified as pre-ICH (0–365 days before) and post-ICH (30–365 days after). Area-level socioeconomic status was defined by 3-digit zip-code-based socioeconomic deprivation index (zSDI) tertiles relative to the population. The primary outcome was uncontrolled average systolic BP (≥140 mmHg) at each time point. We used adjusted multivariable logistic regression to estimate the odds of post-ICH uncontrolled BP and causal mediation analysis to identify mediators of identified associations. Results: We included 1,793 ICH survivors with at least one BP measurement pre- or post-ICH (mean age 61.2 years; 48.7% female). Black participants had higher rates of uncontrolled BP than White participants pre-ICH (41.1% vs 22.2%; n=1,453; p<0.001) and post-ICH (33.1% vs 16.0%; n=1,501; p<0.001) (Fig. 1). High zSDI was also associated with worse BP control pre-ICH (29.6% vs 22.2%; p=0.011) and post-ICH (24.4% vs 13.9%; p<0.001) (Fig. 1). In adjusted logistic regression (Fig. 2), Black vs White race (OR 3.02, 95% CI 2.15–4.26; p<0.001) and high vs low zSDI (OR 1.74, 95% CI 1.21–2.50; p=0.003) were associated with uncontrolled post-ICH BP. Mediation analysis (Fig. 3) showed pre-ICH BP control explained 29.4% (p<0.001) of the Black–White disparity and 26.9% (p=0.04) of the high–low zSDI disparity in post-ICH BP control. Conclusion: In this diverse U.S.-based cohort, pre-ICH uncontrolled BP was a significant risk factor for post-ICH uncontrolled BP and mediator of disparities in BP control across social groups. These findings highlight the need for both upstream efforts to improve hypertension management in vulnerable populations and downstream interventions targeted at ICH survivors to ensure equitable secondary prevention post-ICH. Addressing both independently is likely critical to reducing disparities in stroke incidence and recurrence.
Namian et al. (2026) studied this question. Black participants had 3.02 times higher odds and those with high socioeconomic deprivation 1.74 times higher odds of uncontrolled post-ICH BP compared to their counterparts.