HKUMed has developed the 'TRICH score', an innovative clinical tool to help physicians effectively identify intracerebral hemorrhage patients who may benefit from early triple anti-hypertensive treatment. Pictured from right: Dr Teo Kay-cheong, Dr Gary Lau Kui-kai and Adrian So Ching-hei.
In a significant advancement for stroke care, researchers from HKU Stroke and the Department of Medicine, School of Clinical Medicine at the LKS Faculty of Medicine of the University of Hong Kong (HKUMed) have developed the TRICH score. This innovative clinical tool is designed to help physicians effectively identify intracerebral hemorrhage (ICH) patients who would benefit from early prescription of triple anti-hypertensive medication. The TRICH score addresses a critical need in hypertension care after ICH by facilitating timely and effective blood pressure control. It also has the potential to significantly reduce the risk of ICH recurrence and subsequent strokes. The findings were published in the international journal Neurology [link to publication].
In addition to the TRICH Score, HKU Stroke is conducting a separate study on the use of telemedicine for hypertension management in ICH patients, further enhancing their approach to patient care.
Background
ICH, the second most common form of stroke, accounts for 50% of all stroke-related deaths in Asian countries and is a major cause of long-term disability. Effective blood pressure control after ICH is pivotal for improving long-term outcomes, but it can be challenging because many patients often experience severe hypertension. Previous research by HKU Stroke showed that most ICH patients fail to control their blood pressure, significantly increasing the risk of ICH recurrence, subsequent strokes and death. At least three anti-hypertensive medications are often needed, but many patients do not receive appropriate treatment for various reasons. There are also concerns about the risks of overtreatment and excessive reduction in blood pressure, which could lead to more side effects, particularly in older patients.
Research findings and significance
The TRICH score was developed by MBBS students Adrian So Ching-hei and Charming Yeung under the supervision of Dr Teo Kay-cheong, Clinical Assistant Professor of the Department of Medicine, School of Clinical Medicine at HKUMed, and Deputy Director of HKU Stroke. This clinical tool has been validated in three local hospitals –Ruttonjee Hospital, Yan Chai Hospital and Princess Margaret Hospital – based on a cohort of 462 ICH patients at Queen Mary Hospital.
The TRICH score comprises five simple clinical predictors: age, sex, kidney function, admission blood pressure, and the presence of ischaemic heart disease. This scoring system allows healthcare providers to identify patients who need aggressive treatment quickly, facilitating prompt blood pressure management while minimising the risks associated with overtreatment and medication side effects in lower-risk cases.
Dr Teo emphasised the importance of effective blood pressure control after an ICH. 'This empowers doctors to give the right treatment at the right time,' he explained. Since ICH patients often experience more severe hypertension, new approaches to managing hypertension in this population are needed. 'Patients with poorly controlled hypertension face up to four times greater risk of ICH and stroke, which can lead to significant disability or death,' he said. 'The TRICH score can guide clinicians to adopt early prescription of triple anti-hypertensive medications. Using combination anti-hypertensive pills is preferred to enhance drug compliance.'
Dr Teo highlighted the role of telemedicine in enhancing hypertension management. In addition to the TRICH score, HKU Stroke is pioneering the MOBILE-ICH (MOBILE health intervention in IntraCerebral Hemorrhage survivors) study, to investigate the safety and efficacy of telemedicine for managing hypertension in ICH patients.
'As an undergraduate medical student, I find it incredibly rewarding to realise that my research during my Enrichment Year could significantly impact clinical practice and patient outcomes.' said Adrian So, who conducted the research during his Year 3 Enrichment Year (EY). The EY is a compulsory credit-bearing component for HKUMed's Bachelor of Medicine and Bachelor of Surgery (MBBS) Year 3 students, allowing them to take charge of their learning and tailor activities to their interests. Students can enhance their total learning experience through service or humanitarian work, research attachment or intercalation.
Charming Yeung, who just graduated from HKUMed and will begin working as a doctor in July this year, echoed this sentiment. 'The research journey over the past three years has been challenging, but I've gained valuable knowledge and found the experience worthwhile and meaningful,' she said.
Given that ICH is a severe condition, prevention is also crucial. Effective screening and management of hypertension in the general public can significantly lower the risk of developing this disease. Unfortunately, a separate study found that up to 80% of ICH patients aged 55 or younger have undiagnosed or untreated hypertension. Dr Gary Lau Kui-kai, Director of HKU Stroke and Clinical Associate Professor in Neurology at the Department of Medicine, School of Clinical Medicine at HKUMed, underscored the necessity of addressing hypertension not only in stroke patients but also in the general population. He stated, 'Hypertension, the leading modifiable risk factor for stroke today, often goes unnoticed. Many stroke patients, particularly younger individuals, have undiagnosed or untreated hypertension. The stroke could be prevented with the early intervention of hypertension.'
As World Hypertension Day approaches on 17 May, this research underscores the importance of awareness and proactive management of hypertension to reduce stroke risk and improve patient outcomes.
About the research team
The research was conducted by a team led by Dr Gary Lau Kui-kai, Director of HKU Stroke, and Dr Teo Kay Cheong, Deputy Director, both from the Department of Medicine, School of Clinical Medicine, HKUMed. The mission of HKU Stroke is to better understand what causes stroke, and how to better prevent and manage it. HKU Stroke also strives to improve the well-being of stroke patients and their caregivers. For details, please refer to the website http://stroke.hku.hk.
