Regional Differences in Intracerebral Hemorrhage Outcomes Reported Across 16 Trials

An observational analysis published in Stroke examined regional differences in outcomes after acute intracerebral hemorrhage using pooled individual participant data from 16 completed randomized trials of blood pressure–lowering treatment. Among 6,221 participants, mean age was 63.3 years, 36.4% were female, and 3,494 (56.2%) were from Asia, primarily East and South Asia. Investigators used generalized linear mixed models with inverse probability of treatment weighting to compare outcomes between Asia and non-Asia regions.

At 90 days, participants from Asia had lower weighted odds of death or dependency, defined as modified Rankin Scale scores of 3–6 (OR, 0.67; 95% CI, 0.58–0.77), and major disability, defined as scores of 3–5 (OR, 0.67; 95% CI, 0.57–0.78). Neurological deterioration within seven days was also less likely (OR, 0.70; 95% CI, 0.56–0.89). There were no significant regional differences in hematoma expansion at 24 hours (P=0.97) or death alone at 90 days (P=0.23).

No significant interactions between region and blood pressure–lowering treatment were detected for the assessed outcomes. The findings support considering regional differences when designing and interpreting ICH outcome studies, rather than establishing region-specific treatment effects. Although the data originated from randomized trials, the regional comparison was observational and cannot establish causation. Only the abstract was available for this assessment.