Elevated blood pressure (BP) independently predicts poor outcomes for patients with acute intracerebral hemorrhage (ICH). The INTERACT2 trial published in 2013 is found to produce better functional outcomes without harming patients with ICH who underwent early intensive BP lowering (systolic BP target <140 mmHg) within 6 hours of onset. These outcomes resulted in revisions of guidelines for the acute BP management of patients with ICH, in which, intensive BP lowering is recommended as safe and effective for improving functional outcomes. However, the ATACH-II trial found no difference in the frequency of death and disability at 90 days between patients treated with “very early” (<4.5 hours of onset) and “very rapid and intensive” BP lowering (systolic BP <140 mmHg with intravenous nicardipine for 24 hours) and with standard BP management. Therefore, a lower limit of target BP and an optimal method of reducing BP remain to be clarified. Evidence does support the notion that long-term BP lowering is the single most significant intervention for the secondary prevention of ICH. Several guidelines recommend a target BP of <130/80 mmHg after ICH, but this is supported by limited evidence. An ongoing randomized controlled trial (TRIDENT) is aiming to determine the effectiveness of more intensive BP lowering using a fixed low-dose combination of agents such as telmisartan, amlodipine, and indapamide (“Triple Pill” strategy) in addition to standard care, on the time to first occurrence of recurrent stroke among over 4,200 patients with ICH worldwide, including Japan.
"},{"@language":"ja","@value":"脳出血急性期の血圧上昇は，転帰不良の強力な予測因子である．発症6 時間以内の急性期脳出血に対する積極降圧療法（目標収縮期血圧<140 mmHg）の有効性を検討したThe Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Tria（l INTERACT）2試験により，急性期の積極降圧療法が機能的転帰を改善することが示され，国内外のガイドラインの記載が相次いで改訂された．しかし，最近発表されたAntihypertensive Treatment of Acute Cerebral Hemorrhage（ATACH）-II 試験では，発症4.5 時間以内の患者を対象に，より厳格な降圧療法の効果を検討したが，転帰改善効果は証明されなかった．したがって，脳出血急性期における降圧目標の下限や最適な降圧方法に関してはいまだ明らかになっていない．脳卒中再発防止における降圧療法の有用性は証明されており，複数のガイドラインで130/80 mmHg 未満のコントロールを推奨している．しかし，これを直接支持する無作為化比較試験のエビデンスは乏しく，現在，国際共同試験Triple Therapy Prevention of Recurrent Intracerebral Disease EveNts Tria（l TRIDENT）が進行中である．
"}],"abstractLicenseFlag":"disallow"}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1410001288118414592","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000399380294"}],"foaf:name":[{"@language":"ja","@value":"佐藤 祥一郎"},{"@language":"en","@value":"Sato Shoichiro"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center"},{"@language":"ja","@value":"国立循環器病研究センター脳血管内科"}]}],"publication":{"publicationIdentifier":[{"@type":"PISSN","@value":"09120726"},{"@type":"LISSN","@value":"09120726"},{"@type":"EISSN","@value":"18831923"}],"prism:publicationName":[{"@language":"en","@value":"Japanese Journal of Stroke"},{"@language":"ja","@value":"脳卒中"},{"@language":"en","@value":"Nosotchu"},{"@language":"en","@value":"Jpn. J. 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