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Is hypertension a more frequent risk factor for deep than for lobar supratentorial intracerebral haemorrhage?
Open accessAbstract
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, 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]
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“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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Metadata
- Authors
- Jackson, C. A., & Sudlow, C. L. M.
- Affiliations
- Western General Hospital (GB)
- Corresponding author
- Jackson, C A
- Venue
- Journal of Neurology, Neurosurgery & Psychiatry
- Publisher
- BMJ
- Published
- 2006-05-11
- Volume
- 77
- Issue
- 11
- Pages
- 1244-1252
- ISSN
- 0022-3050 (ISSN-L)
- 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 › Clinical Neurology › Intracerebral and Subarachnoid Hemorrhage Research
- Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Clinical 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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