Clinical Outcome Differences in Asia Versus Non-Asia Intracerebral Hemorrhage: IPD Analysis From BP-Lowering Clinical Trials

BACKGROUND: Evidence of regional differences in clinical outcomes after intracerebral hemorrhage (ICH) is still scarce. We quantified differential outcomes and response to early intensive blood pressure lowering treatment by region in the Blood pressure in Acute Stroke Collaboration ICH data set. METHODS: This was an observational analysis of pooled individual participant data from 16 completed randomized controlled trials of blood pressure-lowering treatment in acute ICH, based on the Blood pressure in Acute Stroke Collaboration data set. Generalized linear mixed models with inverse probability of treatment weighting (IPTW) were used to determine the association between regions (Asia [primarily East and South Asia] versus non-Asia) and clinical outcomes including neurological deterioration within 7 days, hematoma expansion at 24 hours (absolute ≥6 mL or relative ≥33%), and death or dependency (modified Rankin Scale scores, 3–6), major disability(modified Rankin Scale score, 3–5), death alone at 90 days. RESULTS: Among 6221 patients (age, 63.3±13.0 years; female 36.4%), 3494 (56.2%) were from Asia. ICH participants from Asia had a significantly reduced risk of death or dependency (unadjusted odds ratio [OR], 0.44 [95% CI, 0.39–0.51]; IPTW-weighted OR, 0.67 [95% CI, 0.58–0.77]); and major disability (unadjusted OR, 0.49 [95% CI, 0.42–0.56]; IPTW-weighted OR, 0.67 [95% CI, 0.57–0.78]) at 90 days, neurological deterioration (unadjusted OR, 0.63 [95% CI, 0.52–0.77]; IPTW-weighted OR, 0.70 [95% CI, 0.56–0.89]) within 7 days, in comparison to those from non-Asia regions. However, there were no differences for hematoma expansion ( P =0.97) at 24 hours or death ( P =0.23) at 90 days using IPTW. Additionally, there were no significant interactions between blood pressure–lowering treatment and region (Asia versus non-Asia) for either outcome using IPTW. CONCLUSIONS: Participants from East and South Asia had a favorable functional recovery and a lower risk of neurological deterioration compared with those from non-Asian regions after adjustment for confounders, with no differences in hematoma expansion at 24 hours after ICH. These findings suggest that future ICH studies on clinical outcomes should consider regional differences.

Authors

Institutions

Publication Details

Journal
Stroke
Published
2026-10-14
DOI
https://doi.org/10.1161/strokeaha.126.055677
Primary Topic
Intracerebral and Subarachnoid Hemorrhage Research
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Clinical Outcome Differences in Asia Versus Non-Asia Intracerebral Hemorrhage: IPD Analysis From BP-Lowering Clinical Trials

Xinwen Ren, Else Charlotte Sandset, Nerses Sanossian, Adnan Iqbal Qureshi et al.
Stroke
Intracerebral and Subarachnoid Hemorrhage Research
article

Clinical Outcome Differences in Asia Versus Non-Asia Intracerebral Hemorrhage: IPD Analysis From BP-Lowering Clinical Trials

Xinwen Ren, Else Charlotte Sandset, Nerses Sanossian, Adnan Iqbal Qureshi, Shoujiang You, Lisa Jane Woodhouse, Sebastian Koch, Menglu Ouyang, Rustam Al‐Shahi Salman, Candice Delcourt, Thompson Gordon Robinson, Zhe Kang Law, Nikola Sprigg, Kailash Krishnan, Lili Song, Jeffrey L. Saver, Tom J. Moullaali, Hisatomi Arima, Yongjun Cao, Eivind Berge, Philip M W Bath, Ken Butcher, Craig S. Anderson, Qiao Han, Leon Edwards, J Horn, Wen Jiang, Joanna Wardlaw, Xia Wang, Salil Gupta, Qiang Li, John Chalmers, John Potter, Chen Chen, Yuko Palesch
article en

Abstract

BACKGROUND: Evidence of regional differences in clinical outcomes after intracerebral hemorrhage (ICH) is still scarce. We quantified differential outcomes and response to early intensive blood pressure lowering treatment by region in the Blood pressure in Acute Stroke Collaboration ICH data set. METHODS: This was an observational analysis of pooled individual participant data from 16 completed randomized controlled trials of blood pressure-lowering treatment in acute ICH, based on the Blood pressure in Acute Stroke Collaboration data set. Generalized linear mixed models with inverse probability of treatment weighting (IPTW) were used to determine the association between regions (Asia [primarily East and South Asia] versus non-Asia) and clinical outcomes including neurological deterioration within 7 days, hematoma expansion at 24 hours (absolute ≥6 mL or relative ≥33%), and death or dependency (modified Rankin Scale scores, 3–6), major disability(modified Rankin Scale score, 3–5), death alone at 90 days. RESULTS: Among 6221 patients (age, 63.3±13.0 years; female 36.4%), 3494 (56.2%) were from Asia. ICH participants from Asia had a significantly reduced risk of death or dependency (unadjusted odds ratio [OR], 0.44 [95% CI, 0.39–0.51]; IPTW-weighted OR, 0.67 [95% CI, 0.58–0.77]); and major disability (unadjusted OR, 0.49 [95% CI, 0.42–0.56]; IPTW-weighted OR, 0.67 [95% CI, 0.57–0.78]) at 90 days, neurological deterioration (unadjusted OR, 0.63 [95% CI, 0.52–0.77]; IPTW-weighted OR, 0.70 [95% CI, 0.56–0.89]) within 7 days, in comparison to those from non-Asia regions. However, there were no differences for hematoma expansion ( P =0.97) at 24 hours or death ( P =0.23) at 90 days using IPTW. Additionally, there were no significant interactions between blood pressure–lowering treatment and region (Asia versus non-Asia) for either outcome using IPTW. CONCLUSIONS: Participants from East and South Asia had a favorable functional recovery and a lower risk of neurological deterioration compared with those from non-Asian regions after adjustment for confounders, with no differences in hematoma expansion at 24 hours after ICH. These findings suggest that future ICH studies on clinical outcomes should consider regional differences.

Stroke
University of East Anglia (GB), Oslo University Hospital (NO), Nottingham University Hospitals NHS Trust (GB), University of Miami (US), University of California, Los Angeles (US), Norfolk and Norwich University Hospital (GB), Stiftelsen Norsk Luftambulanse (NO), Royal Prince Alfred Hospital (AU), Fukuoka University (JP), Soochow University (CN), Prince of Wales Hospital (AU), The George Institute for Global Health (AU), Second Affiliated Hospital of Soochow University (CN), Shanghai East Hospital (CN), Xijing Hospital (CN), Shanghai Center for Brain Science and Brain-Inspired Technology (CN), Army Hospital Research and Referral (IN), NIHR Leicester Biomedical Research Centre (GB), University of Missouri (US), Macquarie University (AU), Air Force Medical University (CN)
Good health and well-being
Openalex Percentile: Top 26%
Intracerebral and Subarachnoid Hemorrhage Research
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.