Background: It is unknown if race/ethnicity modifies the response to blood pressure (BP) lowering treatment after intracerebral hemorrhage (ICH). We aimed to examine the race/ethnicity differences in the response to BP lowering treatment after ICH. Methods: This is a post hoc analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2) trial. The primary outcome is good outcome, defined as 90-day modified Rankin Scale 0–3. The primary predictor is race/ethnicity for which we included non-Hispanic categories of White, Black, Asian, and the category of Hispanic. We fit adjusted logistic regression models with the predictor of race/ethnicity and models with the interaction term of treatment*race/ethnicity. Results: We included a total of 953 patients in our analysis (White = 213, Black = 112, Asian = 554, and Hispanic = 74). In the models with the interaction between race/ethnicity and treatment, we found that White patients assigned to the intensive treatment arm had lower predicted probability of good outcome than those assigned to the standard treatment arm (Model 1: 56.2% vs. 68.1%, p = .027; Model 2: 53.4% vs. 68.3%, p = .009). When divided into White and non-White groups, intensive treatment was associated with higher odds of serious adverse events in White group but not in the non-White group. In addition, there was an association between intensive treatment and higher risk of hematoma expansion in White patients and lower risk of hematoma expansion in non-White patients. Conclusions: In the ATACH-2, there was an interaction between race/ethnicity and response to BP lowering treatment after ICH, with White patients having an association between intensive blood pressure reduction and worse outcome.

1. Moullaali, TJ, Wang, X, Martin, RH, et al. Blood pressure control and clinical outcomes in acute intracerebral haemorrhage: A Preplanned Pooled Analysis of Individual Participant Data. Lancet Neurol 2019; 18: 857–864.
Google Scholar | Crossref | Medline2. Qureshi, AI, Palesch, YY, Barsan, WG, et al. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. New Engl J Med 2016; 375: 1033–1043.
Google Scholar | Crossref | Medline | ISI3. Tsivgoulis, G, Katsanos, AH, Butcher, KS, et al. Intensive blood pressure reduction in acute intracerebral hemorrhage: A Meta-Analysis. Neurology 2014; 83(17): 1523–1529.
Google Scholar | Crossref | Medline4. Sandset, EC, Anderson, CS, Bath, PM, et al. European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage. Eur Stroke J 2021; 6(2): I-XLVII.
Google Scholar | SAGE Journals5. Gupta, AK . Racial differences in response to antihypertensive therapy: does one size fits all?. Int J Prev Med 2010; 1: 217.
Google Scholar | Medline6. Jones, DW, Hall, JE. Racial and ethnic differences in blood pressure: biology and sociology. Circulation 2006; 114(25):2757–2759.
Google Scholar | Crossref | Medline7. Profant, J, Dimsdale, JE. Race and diurnal blood pressure patterns: a review and meta-analysis. Hypertension 1999; 33: 1099–1104.
Google Scholar | Crossref | Medline | ISI8. Wang, X, Poole, JC, Treiber, FA, et al. Ethnic and gender differences in ambulatory blood pressure trajectories. Circulation 2006; 114: 2780–2787.
Google Scholar | Crossref | Medline9. Gupta, AK, Poulter, NR, Dobson, J, et al. Ethnic differences in blood pressure response to first and second-line antihypertensive therapies in patients randomized in the ASCOT Trial. Am J Hypertens 2010; 23: 1023–1030.
Google Scholar | Crossref | Medline | ISI10. Tibshirani, R . Regression shrinkage and selection via the lasso. J R Stat Soc Ser B (Methodological). 1996; 58(1): 267–288.
Google Scholar11. Flaherty, ML, Woo, D, Haverbusch, M, et al. Racial variations in location and risk of intracerebral hemorrhage. Stroke 2005; 36: 934–937.
Google Scholar | Crossref | Medline | ISI12. Koch, S, Elkind, MS, Testai, FD, et al. Racial-ethnic disparities in acute blood pressure after intracerebral hemorrhage. Neurology 2016; 87: 786–791.
Google Scholar | Crossref | Medline13. Krishnan, K, Beishon, L, Berge, E, et al. Relationship between race and outcome in asian, black, and Caucasian patients with spontaneous intracerebral hemorrhage: Data from the Virtual International Stroke Trials Archive and Efficacy of Nitric Oxide in Stroke trial. Int. J Stroke 2018; 13: 362–373.
Google Scholar | SAGE Journals | ISI14. Miyares, LC, Falcone, GJ, Leasure, A, et al. Race/ethnicity influences outcomes in young adults with supratentorial intracerebral hemorrhage. Neurology 2020; 94: e1271–e1280.
Google Scholar | Crossref | Medline15. Xian, Y, Holloway, RG, Smith, EE, et al. Racial/ethnic differences in process of care and outcomes among patients hospitalized with intracerebral hemorrhage. Stroke 2014; 45: 3243–3250.
Google Scholar | Crossref | Medline | ISI