Antihypertensive treatment non-adherence and spontaneous intracerebral hemorrhage: a prospective observational study from Northern India

Intracerebral hemorrhage (ICH) is a leading cause of stroke-related mortality and long-term disability, with a disproportionate burden in low- and middle-income countries. Hypertension, and particularly non-adherence to antihypertensive therapy, represents the most important modifiable risk factor. This study aimed to evaluate the epidemiological, clinical, and radiological characteristics of hypertensive ICH and to identify preventable risk factors with public health relevance. A prospective observational study was conducted at a tertiary-care referral center in Northern India between March 2023 and February 2024. Adult patients with non-traumatic spontaneous intracerebral hemorrhage were enrolled. Data on demographics, cardiovascular risk factors, antihypertensive treatment adherence, clinical severity, and radiological characteristics were collected and analyzed descriptively. One hundred patients were included (mean age 61.2 ± 12.4 years; 63% male). Hypertension was present in 78% of patients; among these, 70.5% (95% CI 59.6 to 79.5) reported non-adherence to antihypertensive therapy. Active smoking was observed in 62%. Deep hemorrhages involving the basal ganglia (46%) and thalamus (26%) accounted for 72% of cases. Hydrocephalus occurred in 28%. Higher admission blood pressure was observed in patients with larger hematoma volumes. Hypertensive ICH in this Northern Indian cohort disproportionately affects individuals in the sixth decade of life and is strongly associated with uncontrolled blood pressure, antihypertensive treatment non-adherence, and tobacco use. Targeted primary prevention through strengthened antihypertensive care and behavioral risk factor programs is essential to reducing the regional burden of this largely preventable condition.