Types of Recurrent Stroke in Survivors of Intracerebral Hemorrhage

Types of Recurrent Stroke in Survivors of Intracerebral Hemorrhage To the Editor: I read with great interest the recent article1 by Arakawa and colleagues. In this important study, Arakawa and colleagues followed up 74 patients with hypertensive brain hemorrhage for a mean of 2.8 years and reported higher diastolic blood pressure (DBP) but not higher systolic blood pressure (SBP) as the risk factor for recurrent brain hemorrhage. I would make the following comments. First, recurrent stroke affected 9 of the 74 patients; the type of recurrent stroke was intracerebral hemorrhage (ICH) in 8 (89%) and ischemic stroke (IS) in 1 (11%).1 Although most of the recurrent strokes are of the same type as the first episode in patients surviving from IS, this may not apply to survivors of ICH. In a study by Yamamoto and Bogousslavsky,2 the recurrent strokes were of the same type as the initial strokes in 77% of patients with cardioembolic IS, 65% with nonlacunar noncardioembolic IS, 58% with ICH, and 48% with lacunar IS. I wonder whether Arakawa and colleagues have any explanation for the high consistency rate of 89% of recurrent ICH observed in their cohort. From our database of information prospectively gathered between October 1996 and January 1999 (Cheung, unpublished data, 1999), 138 of 607 stroke patients had a previous history of stroke. Of 120 patients with a previous history of IS, the type of recurrent stroke was IS in 108 (90%) and ICH in 12 (10%). Of 16 patients with a previous history of ICH, the recurrent stroke was ICH in 5 (31%) and IS in 11 (69%). Two patients had a history of subarachnoid hemorrhage; one had a recurrent ICH and the other a recurrent IS. Second, arterial blood pressure was monitored monthly in the cohort of 74 patients, and the mean values of SBP and DBP were used in the analysis.1 I would like to know the range of the SBP and DBP in the 2 subgroups of patients as defined by the recurrent ICH. In addition, I wonder whether the SBP and DBP values were greater in the period immediately before the recurrent ICH, suggesting a close temporal relationship between blood pressure control and recurrent ICH.