The association of first follow-up blood pressure level with recurrent stroke and mortality in survivors of spontaneous intracerebral hemorrhage.

Although blood pressure is an important modifiable factor for the prevention of recurrent stroke after spontaneous intracerebral hemorrhage (ICH), the target blood pressure remains uncertain. Using the National Health Insurance Service database from January 2005 to December 2022, patients who survived for more than one year with prescribed antihypertensive drugs were identified. We compared the risks of mortality, ischemic stroke, and recurrent ICH among six groups divided according to systolic blood pressure (SBP). SBP was assessed at the first available health examination within 1 year after the index ICH and the date of SBP measurement was defined as the index date.The incidence rates, hazard ratios, and 95% confidence intervals were estimated using the Cox proportional hazards model. Among the 11,034 ICH survivors, 5-year incidence rates of mortality, ischemic stroke, and recurrent ICH were 13.26 per 1000 person-year, 7.71, and 12.90, respectively. Mortality incidence was lowest in the SBP 120-129 mmHg group, and SBP ≥ 160 mmHg was associated with a higher risk of mortality (adjusted HR [aHR]: 1.55 [95% CI 1.06-2.28]) compared with the reference group. Acute ischemic stroke followed linear increasing trend with significance at SBP ≥ 150 mmHg (SBP 150-159 mmHg, aHR: 1.80 [95% CI 1.18-2.74]), while recurrent ICH was significantly increased at SBP ≥ 160 mmHg (aHR: 1.87 [95% CI 1.27-2.74]). The present study showed that SBP between 120-129 mmHg was associated with the lowest risk of mortality, while higher SBP levels were associated with increased risk of ischemic stroke and ICH recurrence. These findings suggest a designated blood pressure range for managing this high-risk population.