Type of Substance Use Predicts Hemorrhage versus Ischemia (P5.137)

OBJECTIVE: To determine the relationship between specific substances of abuse and intracerebral hemorrhage (versus ischemia) in hypertensive patients. BACKGROUND: Hypertension damages small blood vessels, resulting in both lacunar infarction and subcortical intracerebral hemorrhage (ICH). Substance abuse has also been linked to small vessel pathology. This study explores whether the use of specific substances (eg., cocaine and smoking) is associated with ICH over ischemia in hypertensive individuals. DESIGN/METHODS: Patients with hypertension admitted with subcortical lacunar infarcts (measuring 1 drink per day (women), >2 drinks per day (men). Logistic regression was performed with ICH as the dependent variable. RESULTS: Of the 580 patients included in analysis, 217 (37%) presented with ICH. The average age was similar between the two groups (64.7 versus 66.3 years). Illicit drug use was associated with a significantly increased risk of ICH over stroke in unadjusted models (25% versus 15%, p=0.02), with the largest effect seen in users 蠅65 years old. Smoking was associated with ischemia over ICH in a dose-dependent manner: any history of smoking OR 1.84, CI 1.19-2.84; current use OR 2.23, CI 1.37-3.62; heavy use OR 2.48, CI 1.50-4.13. Alcohol use was not preferentially associated with either outcome (p=0.29). CONCLUSIONS: In hypertensive patients, tobacco use is highly associated with an increased risk of ischemia compared to ICH, while use of illicit substances, especially in the elderly, appears to be predictive of hemorrhage. Disclosure: Dr. Kaplan has nothing to disclose. Dr. Gottesman has nothing to disclose. Dr. Llinas has nothing to disclose. Dr. Marsh has nothing to disclose.