Intracerebral haemorrhage outcomes worse in women than in men

Women face a greater risk of death or disability following intracerebral haemorrhage (ICH), but whether intensive systolic blood pressure (BP)-lowering therapy in acute ICH is more beneficial to women than men is unclear, according to data from the ATACH-2* trial.

In ATACH-2, ICH patients were randomly assigned to intensive (target systolic BP, 110–139 mm Hg) or standard (140–179 mm Hg) BP-lowering therapy within 4.5 hours after onset. Researchers estimated the risk of death or disability corresponding to the modified Rankin Scale score of 4–6, as well as assessed interaction between sex and treatment.

The analysis included 380 women and 620 men enrolled in ATACH-2. The women were older, commonly prescribed antihypertensive drugs before the onset of ICH, and more frequently had lobar ICH. On the other hand, haematoma expansion and perihematomal oedema expansion were observed with greater frequency in men.

More women than men died or were disabled following ICH (44.3 percent vs 34.3 percent). Indeed, multivariable analysis showed that the risk of death or disability was 19 percent higher in women (relative risk [RR], 1.19, 95 percent confidence interval [CI], 1.02–1.37; p=0.023).

The RR of death or disability associated with intensive vs standard BP-lowering therapy was 0.91 (95 percent CI, 0.74–1.13) in women and 1.13 (95 percent CI, 0.92–1.39) in men (p_interaction=0.11), with inconclusive Gail-Simmon test (p=0.16).

The researchers outlined potential reasons why ICH outcomes are more unfavourable in women than men. First is because of a higher prevalence of poststroke depression in women. Another is the higher incidence of frailty, which may attenuate the functional recovery.

*Antihypertensive Treatment in Intracerebral Hemorrhage-2