Blood Pressure-Attained Analysis of ATACH 2 Trial
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- Adnan I. Qureshi
- From the Department of Neurology, Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis (A.I.Q., M.H.Q.)
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- Yuko Y. Palesch
- Department of Public Health Sciences, Medical University of South Carolina, Charleston (Y.Y.P., L.D.F.)
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- Lydia D. Foster
- Department of Public Health Sciences, Medical University of South Carolina, Charleston (Y.Y.P., L.D.F.)
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- William G. Barsan
- Department of Emergency Medicine, University of Michigan, Ann Arbor (W.G.B., R.S.)
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- Joshua N. Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
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- Daniel F. Hanley
- Department of Neurology, Johns Hopkins University, Baltimore, MD (D.F.H.)
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- Chung Y. Hsu
- Department of Neurology, China Medical University, Taichung, Taiwan (C.Y.H.)
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- Claudia S. Moy
- Division of Clinical Research, National Institutes of Health, Bethesda, MD (C.S.M.)
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- Mushtaq H. Qureshi
- From the Department of Neurology, Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis (A.I.Q., M.H.Q.)
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- Robert Silbergleit
- Department of Emergency Medicine, University of Michigan, Ann Arbor (W.G.B., R.S.)
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- Jose I. Suarez
- Department of Neurology, Baylor College of Medicine, Houston, TX (J.I.S.)
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- Kazunori Toyoda
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., H.Y.).
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- Haruko Yamamoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., H.Y.).
Description
<jats:sec> <jats:title>Background and Purpose—</jats:title> <jats:p>We compared the rates of death or disability, defined by modified Rankin Scale score of 4 to 6, at 3 months in patients with intracerebral hemorrhage according to post-treatment systolic blood pressure (SBP)–attained status.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods—</jats:title> <jats:p>We divided 1000 subjects with SBP ≥180 mm Hg who were randomized within 4.5 hours of symptom onset as follows: SBP <140 mm Hg achieved or not achieved within 2 hours; subjects in whom SBP <140 mm Hg was achieved within 2 hours were further divided: SBP <140 mm Hg for 21 to 22 hours (reduced and maintained) or SBP was ≥140 mm Hg for at least 2 hours during the period between 2 and 24 hours (reduced but not maintained).</jats:p> </jats:sec> <jats:sec> <jats:title>Results—</jats:title> <jats:p>Compared with subjects without reduction of SBP <140 mm Hg within 2 hours, subjects with reduction and maintenance of SBP <140 mm Hg within 2 hours had a similar rate of death or disability (relative risk of 0.98; 95% confidence interval, 0.74–1.29). The rates of neurological deterioration within 24 hours were significantly higher in reduced and maintained group (10.4%; relative risk, 1.98; 95% confidence interval, 1.08–3.62) and in reduced but not maintained group (11.5%; relative risk, 2.08; 95% confidence interval, 1.15–3.75) compared with reference group. The rates of cardiac-related adverse events within 7 days were higher among subjects with reduction and maintenance of SBP <140 mmHg compared to subjects without reduction (11.2% versus 6.4%).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>No decline in death or disability but higher rates of neurological deterioration and cardiac-related adverse events were observed among intracerebral hemorrhage subjects with reduction with and without maintenance of intensive SBP goals.</jats:p> </jats:sec> <jats:sec> <jats:title>Clinical Trial Registration—</jats:title> <jats:p> URL: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov">https://www.clinicaltrials.gov</jats:ext-link> . Unique identifier: NCT01176565. </jats:p> </jats:sec>
Journal
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- Stroke
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Stroke 49 (6), 1412-1418, 2018-06
Ovid Technologies (Wolters Kluwer Health)
