Is hypertension a more frequent risk factor for deep than for lobar supratentorial intracerebral haemorrhage?

Jackson, C A; Sudlow, C L M

doi:10.1136/jnnp.2006.089292

Cited by 103Intracerebral and Subarachnoid Hemorrhage ResearchAcute Ischemic Stroke ManagementIntracranial Aneurysms: Treatment and Complications

Is hypertension a more frequent risk factor for deep than for lobar supratentorial intracerebral haemorrhage?

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Jackson, C A, Sudlow, C L M·2006·Journal of Neurology, Neurosurgery & Psychiatry

DOI 10.1136/jnnp.2006.089292PMC PMC2077396

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Abstract

OBJECTIVE: To determine whether evidence from observational studies supports the widely held belief that hypertension is more commonly a risk factor for deep than for lobar supratentorial intracerebral haemorrhage. METHODS: Studies comparing the frequency of hypertension as a risk factor for deep versus lobar supratentorial intracerebral haemorrhage, excluding haemorrhages with identified secondary causes, were identified and subjected to a meta-analysis. The effects of predefined methodological quality criteria on the results were assessed and other sources of bias were considered. RESULTS: The pooled result from all 28 included studies (about 4000 patients) found hypertension to be about twice as common in patients with deep as in those with lobar haemorrhage (odds ratio (OR) 2.10, 95% confidence interval (95% CI) 1.82 to 2.42), but there was significant heterogeneity between studies. The pooled OR was less extreme for studies that used a pre-stroke definition of hypertension, were population based or included first-ever strokes only. In the three studies meeting all criteria (601 patients), deep haemorrhage was associated with a smaller, statistically significant excess of hypertension (OR 1.50, 95% CI 1.09 to 2.07). The OR for studies confined to younger patients seemed to be more extreme (12.32, 95% CI 6.13 to 24.77), but none of these studies fulfilled our methodological quality criteria. Additional, unquantified sources of bias included uncertainty about whether those doctors reporting brain scans were blind to hypertension status, uncertain reliability of the classification of haemorrhage location and variable rates of investigation for secondary causes. CONCLUSIONS: An excess of hypertension was found in patients with deep versus lobar intracerebral haemorrhages without an identified secondary cause, but this may be due to residual, unquantified methodological biases.

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Non-lobar intracerebral haemorrhages are not thought to be caused by cerebral amyloid angiopathy and are mostly due to perforating arteriolar vasculopathy.
“non-lobar intracerebral haemorrhages, which are not thought to be caused by cerebral amyloid angiopathy, and are mostly due to perforating arteriolar vasculopathy.64,65”
From Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration (2013) · cites this paper as [65]
The paper says cerebral amyloid angiopathy causes mainly lobar haemorrhages and describes a proposed link between deep haemorrhage and disease of small perforating vessels. It does not rule out amyloid angiopathy as a cause of non-lobar haemorrhage or establish that most non-lobar haemorrhages result from perforating arteriolar vasculopathy; it notes uncertainty about that vascular pathology (introductory passage and Discussion; page numbers unavailable). (LLM, conf=0.84)
Experimental — accuracy not yet measured
Lobar intracerebral haemorrhages might be caused by cerebral amyloid angiopathy.
“lobar intracerebral haemorrhages, which might be caused by cerebral amyloid angiopathy”
From Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration (2013) · cites this paper as [65]

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Published Online First
Jackson, C., Sudlow, C. L. M., Jackson, C., & Of, D. (2006)
Self-citation
Prevalence of Hypertension in Deep and Lobar Intracerebral Hemorrhage in a Group of Iraqi Patients
Al‐Saffar, F., Al-Hamadani, H. A., & Mohammad, M. G. (2013) · Journal of the Faculty of Medicine Baghdad · doi:10.32007/jfacmedbagdad.552635
Differential effects of hypertension in the aetiology of major intracerebral haemorrhage subtypes
Anderson, C. S. (2006) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2006.096495
Differential effects of hypertension in the aetiology of major intracerebral haemorrhage subtypes? (Editorial on Jackson CA, Sudlow CLM). Is hypertension a more frequent risk factor for deep than for lobar intracerebral haemorrhage?
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Authors: Jackson, C. A., & Sudlow, C. L. M.
Affiliations: Western General Hospital (GB)
Corresponding author: Jackson, C A
ORCID: Jackson, C A
Sudlow, C L M
Venue: Journal of Neurology, Neurosurgery & Psychiatry
Publisher: BMJ
Published: 2006-05-11
Volume: 77
Issue: 11
Pages: 1244-1252
ISSN: 0022-3050 (ISSN-L)
DOI: 10.1136/jnnp.2006.089292
PMC: PMC2077396
OpenAlex: W2148019553
Cited by: 103
References: 55
Citations by year: 2026: 4 · 2025: 5 · 2024: 3 · 2023: 3 · 2022: 6 · 2021: 10 · 2020: 6 · 2019: 6 · 2018: 8 · 2017: 6 · 2016: 4 · 2015: 7 · 2014: 3 · 2013: 5 · 2012: 3
FWCI: 2.97
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Journal of Neurology Neurosurgery & Psychiatry (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
HighWire Press Open Archive (submittedVersion)
Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
Funders: Wellcome Trust (063668)
Topics: Health Sciences › Medicine › Neurology › Intracerebral and Subarachnoid Hemorrhage Research
Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
Health Sciences › Medicine › Neurology › Intracranial Aneurysms: Treatment and Complications
Keywords: hypertension, intracerebral hemorrhage, lobar hemorrhage, supratentorial hemorrhage, stroke risk factors, methodological bias
MeSH terms: Brain, Cerebral Hemorrhage, Humans, Hypertension, Risk Factors, Odds Ratio

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Is hypertension a more frequent risk factor for deep than for lobar supratentorial intracerebral haemorrhage?

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