{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:41:59Z","timestamp":1784767319376,"version":"3.55.0"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,3,15]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Survivors of intracranial hemorrhage (ICH) are at increased risk for major adverse cardiovascular and cerebrovascular events (MACCE), in the form of recurrent stroke and myocardial Infarction. We investigated whether long\u2010term blood pressure (BP) variability represents a risk factor for MACCE after ICH, independent of average BP.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">We analyzed data from prospective ICH cohort studies at Massachusetts General Hospital and the University of Hong Kong. We captured long\u2010term (ie, visit\u2010to\u2010visit) BP variability, quantified as individual participants\u2019 variation coefficient. We explored determinants of systolic and diastolic BP variability and generated survival analyses models to explore their association with MACCE. Among 1828 survivors of ICH followed for a median of 46.2\u00a0months we identified 166 with recurrent ICH, 68 with ischemic strokes, and 69 with myocardial infarction. Black (coefficient +3.8, SE 1.3) and Asian (coefficient +2.2, SE 0.4) participants displayed higher BP variability. Long\u2010term systolic BP variability was independently associated with recurrent ICH (subhazard ratio [SHR], 1.82; 95% CI, 1.19\u20132.79), ischemic stroke (SHR, 1.62; 95% CI, 1.06\u20132.47), and myocardial infarction (SHR, 1.54; 95% CI, 1.05\u20132.24). Average BP during follow\u2010up did not modify the association between long\u2010term systolic BP variability and MACCE.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Long\u2010term BP variability is a potent risk factor for recurrent hemorrhage, ischemic stroke, and myocardial infarction after ICH, even among survivors with well\u2010controlled hypertension. Our findings support the hypothesis that combined control of average BP and its variability after ICH is required to minimize incidence of MACCE.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.121.024158","type":"journal-article","created":{"date-parts":[[2022,3,5]],"date-time":"2022-03-05T10:53:27Z","timestamp":1646477607000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Long\u2010Term Blood Pressure Variability and Major Adverse Cardiovascular and Cerebrovascular Events After Intracerebral Hemorrhage"],"prefix":"10.1161","volume":"11","author":[{"given":"Juan Pablo","family":"Castello","sequence":"first","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital Boston MA"},{"name":"Henry and Allison McCance Center for Brain Health Massachusetts General Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kay\u2010Cheong","family":"Teo","sequence":"additional","affiliation":[{"name":"Department of Medicine Queen Mary HospitalLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0622-7989","authenticated-orcid":false,"given":"Jessica R.","family":"Abramson","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital Boston MA"},{"name":"Center for Genomic Medicine Massachusetts General Hospital Boston MA"},{"name":"Henry and Allison McCance Center for Brain Health Massachusetts General Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Keins","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital Boston MA"},{"name":"Center for Genomic Medicine Massachusetts General Hospital Boston MA"},{"name":"Henry and Allison McCance Center for Brain Health Massachusetts General Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3135-527X","authenticated-orcid":false,"given":"Courtney E.","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Neurology Boston Medical Center Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian Y. H.","family":"Leung","sequence":"additional","affiliation":[{"name":"Department of Medicine Queen Mary HospitalLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7363-0239","authenticated-orcid":false,"given":"William C. Y.","family":"Leung","sequence":"additional","affiliation":[{"name":"Department of Medicine Queen Mary HospitalLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujie","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medicine Queen Mary HospitalLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Kourkoulis","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital Boston MA"},{"name":"Center for Genomic Medicine Massachusetts General Hospital Boston MA"},{"name":"Henry and Allison McCance Center for Brain Health Massachusetts General Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7310-624X","authenticated-orcid":false,"given":"Evangelos","family":"Pavlos Myserlis","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital Boston MA"},{"name":"Center for Genomic Medicine Massachusetts General Hospital Boston MA"},{"name":"Henry and Allison McCance Center for Brain Health Massachusetts General Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew D.","family":"Warren","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Henry","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital Boston MA"},{"name":"Center for Genomic Medicine Massachusetts General Hospital Boston MA"},{"name":"Henry and Allison McCance Center for Brain Health Massachusetts General Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koon\u2010Ho","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Medicine Queen Mary HospitalLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR"},{"name":"Research Center of HeartBrain, Hormone and Healthy AgingLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond T. F.","family":"Cheung","sequence":"additional","affiliation":[{"name":"Department of Medicine Queen Mary HospitalLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR"},{"name":"Research Center of HeartBrain, Hormone and Healthy AgingLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu\u2010Leong","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Medicine Queen Mary HospitalLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2169-4457","authenticated-orcid":false,"given":"M. Edip","family":"Gurol","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5398-1816","authenticated-orcid":false,"given":"Anand","family":"Viswanathan","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1792-8887","authenticated-orcid":false,"given":"Steven M.","family":"Greenberg","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0053-2002","authenticated-orcid":false,"given":"Christopher D.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital Boston MA"},{"name":"Center for Genomic Medicine Massachusetts General Hospital Boston MA"},{"name":"Henry and Allison McCance Center for Brain Health Massachusetts General Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8657-2418","authenticated-orcid":false,"given":"Kui\u2010Kai","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Medicine Queen Mary HospitalLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR"},{"name":"Research Center of HeartBrain, Hormone and Healthy AgingLKS Faculty of MedicineThe University of Hong Kong Hong Kong SAR"},{"name":"The State Key Laboratory of Brain and Cognitive Sciences The University of Hong Kong Hong Kong SAR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1014-9138","authenticated-orcid":false,"given":"Jonathan","family":"Rosand","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital Boston MA"},{"name":"Center for Genomic Medicine Massachusetts General Hospital Boston MA"},{"name":"Henry and Allison McCance Center for Brain Health Massachusetts General Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7063-455X","authenticated-orcid":false,"given":"Alessandro","family":"Biffi","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital Boston MA"},{"name":"Center for Genomic Medicine Massachusetts General Hospital Boston MA"},{"name":"Henry and Allison McCance Center for Brain Health Massachusetts General Hospital Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2013-306476"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000007654"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/braincomms\/fcz018"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.026207"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1159\/000441084"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.10082"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.563932"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.12997\/jla.2020.9.2.255"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4098"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.032824"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000005729"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2017.06.015"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2017.06.015"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25079"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.017719"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYP.0000000000000065"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1348\/000711002159680"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000106480.76217.6F"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.611566"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(10)70066-1"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000069"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/ijs.12309"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-020-01564-3"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.119.14443"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.112.663047"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.030427"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11906-019-0962-7"},{"key":"e_1_3_2_29_2","first-page":"64","article-title":"Update on the Hong Kong reference framework for hypertension care for adults in primary care settings\u2010review of evidence on the definition of high blood pressure and goal of therapy","volume":"25","author":"Lim MK","year":"2019","unstructured":"Lim MK, Ha SCN, Luk KH, Yip WK, Tsang CSH, Wong MCS. Update on the Hong Kong reference framework for hypertension care for adults in primary care settings\u2010review of evidence on the definition of high blood pressure and goal of therapy. Hong Kong Med J. 2019;25:64\u201367. doi: 10.12809\/Hkmj187701","journal-title":"Hong Kong Med J"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-023927"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-019-09443-5"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.026739"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.024449"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.121.024158","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:40:48Z","timestamp":1715600448000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.121.024158"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,15]]},"references-count":32,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,3,15]]}},"alternative-id":["10.1161\/JAHA.121.024158"],"URL":"https:\/\/doi.org\/10.1161\/jaha.121.024158","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,15]]},"assertion":[{"value":"2021-10-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-01-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-03-05","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e024158"}}