Innovative Scoring System and Telemedicine Pave the Way for Improved Hypertension Management Post-Stroke

Researchers at the University of Hong Kong (HKU) have made a significant breakthrough in post-stroke care with the introduction of a new clinical tool known as the TRICH score, aimed at enhancing the management of hypertension in patients who have suffered from intracerebral hemorrhage (ICH).

The TRICH score is designed to assist healthcare professionals in identifying ICH patients who would benefit from an early prescription of triple antihypertensive medications. This tool is particularly crucial in addressing the urgent need for effective blood pressure control in the aftermath of ICH, which can help mitigate the risk of recurrent hemorrhages and subsequent strokes.

The findings related to the TRICH score have been published in the journal Neurology.

Alongside the TRICH score, HKU is also exploring the implementation of telemedicine for hypertension management in ICH patients, which represents a progressive step in patient care.

ICH, the second most prevalent type of stroke, is responsible for half of all stroke-related fatalities in Asian countries and is a major contributor to long-term disability. Effective management of blood pressure post-ICH is critical for improving patient outcomes, yet many patients face challenges due to severe hypertension.

Previous studies conducted by HKU Stroke indicated that a significant number of ICH patients struggle to regulate their blood pressure, thereby increasing their risk of experiencing recurrent hemorrhages, additional strokes, and even death. While a combination of at least three antihypertensive medications is often necessary, many patients do not receive adequate treatment due to various barriers.

Moreover, there are concerns regarding the potential dangers of overtreatment, particularly excessive blood pressure reduction, which may lead to additional side effects, especially in older demographics.

The TRICH score was developed under the guidance of Dr. Teo Kay-cheong, a Clinical Assistant Professor at HKUMed, and was validated across three local hospitals: Ruttonjee Hospital, Yan Chai Hospital, and Princess Margaret Hospital, involving a cohort of 462 ICH patients from Queen Mary Hospital.

This scoring system incorporates five straightforward clinical indicators: age, sex, kidney functionality, admission blood pressure, and the presence of ischemic heart disease. By employing this scoring method, healthcare providers can swiftly identify patients requiring aggressive treatment, thereby facilitating timely blood pressure management while also minimizing the risks associated with both overtreatment and medication side effects in lower-risk individuals.

Dr. Teo underscored the significance of effective blood pressure regulation following an ICH. He emphasized that the TRICH score empowers clinicians to administer the appropriate treatment promptly. Given that patients with ICH often exhibit more severe hypertension, innovative strategies for managing this condition are essential.

"Patients experiencing poorly controlled hypertension are at a fourfold increased risk of ICH and stroke, leading to serious disability or fatality," Dr. Teo noted. "The TRICH score offers a framework for clinicians to initiate early prescriptions for triple antihypertensive medications, and utilizing combination antihypertensive pills is preferred to improve medication adherence."

The role of telemedicine in optimizing hypertension management is also a focal point for HKU Stroke. Their ongoing MOBILE-ICH (Mobile Health Intervention for IntraCerebral Hemorrhage Survivors) study is dedicated to evaluating the safety and efficacy of telemedicine in the hypertension management of ICH patients.

One of the student researchers, Adrian So, reflected on the significance of the project, noting the rewarding nature of contributing to clinical practices that could enhance patient outcomes through research.

Charming Yeung, another student involved in the research, echoed similar sentiments, emphasizing the invaluable knowledge gained during their challenging yet meaningful research journey.

In light of the severe implications of ICH, preventative measures are equally vital. Effective hypertension screening and management in the general populace can substantially reduce the risk of developing this condition. Alarmingly, a separate study revealed that up to 80% of ICH patients aged 55 or younger remain undiagnosed or untreated for hypertension.

Dr. Gary Lau Kui-kai, Director of HKU Stroke and Clinical Associate Professor in Neurology at HKUMed, highlighted the urgent need to address hypertension not only among stroke patients but also within the broader community. He pointed out that hypertension is the leading modifiable risk factor for strokes, often going unnoticed, especially among younger stroke patients who may have undiagnosed or untreated hypertension. Early intervention in hypertension could be pivotal in stroke prevention.