Julia Zabinska1, Teng Peng2, Rachel Forman3, Anna Schwartz1, Audrey Leasure1, Maia Schlechter1, Guido Falcone1, Adam De Havenon3, Lauren Sansing1, Dheeraj Lalwani1, Nethra Parasuram1, Vineetha Yadlapalli1, Cheryl Bushnell4, Michael Mullen5, Jordana Cohen6, Debbie Cohen6, Steven Messe7, Kevin Sheth8
1Yale School of Medicine, 2Yale New Haven Hospital, 3Yale University, 4Wake Forest School of Medicine, 5Temple University, 6University of Pennsylvania, 7Hospital of the University of Pennsylvania, 8Yale University Division of Neuro and Critical Care
Objective:
The objective of our study is to evaluate potential biomarkers of persistent hypertension (HTN) in patients with intracerebral hemorrhage (ICH).
Background:
HTN is a modifiable risk factor for ICH recurrence and affects over 80% of patients with ICH; however, less than 40% of these patients achieve BP control. Hyperaldosteronism may be an underdiagnosed cause of HTN and may serve as a biomarker of persistent HTN in an ICH population.
Design/Methods:
The REDUCE trial is an ongoing, multicenter, open-label, randomized clinical trial comparing standard-of-care HTN regimens versus spironolactone-containing regimens in ICH survivors. Baseline electrolytes, aldosterone levels, plasma renin activity, and serial upright BP measurements were obtained prior to randomization. Patients with an average systolic BP ≥ 120 mmHg were randomized. We evaluated whether aldosterone and plasma renin activity could predict persistent HTN in these patients. Low aldosterone was defined as < 2 ng/dL and low plasma renin activity was defined as < 0.7 ng/mL/hr.
Results:
To date, 33 patients have been enrolled in REDUCE (76% male, average age: 62), of which 76% have been randomized (average BP meds pre-randomization: 3). Patients with low aldosterone (< 2 ng/dL) (n=10) were less likely to have average post-ICH systolic BPs of ≥ 120 mmHg (χ2=9.99, p=0.002). Patients with aldosterone levels ≥ 2 ng/dL (n=23) had an average systolic BP of 135 mmHg while patients with lower aldosterone levels (< 2 ng/dL) (n=10) had an average systolic BP of 118 mmHg (p=0.003). Elevated aldosterone remained strongly associated with systolic BP after controlling for age and gender (OR=16.52, 95%CI (1.94-140.87), p=0.01). Plasma renin activity was not associated with systolic BP (p=0.437).
Conclusions:
This preliminary data from the REDUCE trial points to aldosterone as a potential biomarker to predict elevated systolic BP in patients with ICH.