A more aggressive reduction of acute hypertension after ICH does not increase the rate of neurological deterioration even when treatment is initiated within hours of symptom onset. Lowering BP aggressively did not affect hematoma and edema expansion but this possibility deserves further study.

Objective To examine the clinical correlates and survival in patients with anti-fibrillarin antibodies (AFA) in a large international study population consisting of well-characterized systemic sclerosis (SSc) cohorts from Canada, Australia, and the United States of America. Methods Baseline clinical data from the prospective cohorts [Canadian Scleroderma Research Group (CSRG), the Australian Scleroderma Cohort Study (ASCS) and the American Genetics versus Environment in Scleroderma Outcome Study (GENISOS)] were investigated. Clinical variables were harmonized and sera were tested for AFA using a commercially available systemic sclerosis profile line immunoassay (LIA), regardless of the immunofluorescence staining pattern. Association of demographic and clinical features with AFA was investigated by logistic or linear regression. Furthermore, a survival analysis was performed by Cox regression analysis. Results A total of 1506 SSc patients with complete serological profiles were included in the study. Fifty-two (3.5%) patients had antibodies detected against fibrillarin. Patients of African descent and Native North American ethnicity were more likely to be AFA positive compared to other ethnicities. After adjustment for demographic factors, diffuse involvement and intestinal bacterial overgrowth requiring antibiotics, gastrointestinal reflux disease showed a trend for association with AFA. Furthermore, AFA positivity was associated with shorter survival independently of demographic factors and disease type (HR 1.76, 95% CI 1.11, 2.79, p=0.016). Conclusion In this large multinational SSc cohort, AFA was associated with Native American Ethnicity and was an independent predictor of mortality.