Optimal achieved blood pressure in acute intracerebral hemorrhage

Arima, Hisatomi; Heeley, Emma; Delcourt, Candice; Hirakawa, Yoichiro; Wang, X.; Woodward, Mark; Robinson, Thompson; Stapf, Christian; Parsons, Mark; Lavados, Pablo M.; Huang, Yining; Wang, J.; Chalmers, John; Anderson, Craig S.

doi:10.1212/wnl.0000000000001205

Cited by 104 publications

(59 citation statements)

References 23 publications

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“…This analyses could not confirm the other mechanisms stated above. Our earlier analyses have shown a linear relationship between achieved SBP and disability in both the hyperacute (1-24 hours) and acute (2-7 days) phases, 9 and similar findings have been reported in other populations. 10,11 Although our study included a large and heterogeneous population with rigorous prospective and systematic evaluations of both BP and hematoma growth, the analyses are limited by selection bias, inability to establish a causal relationship with treatment, and in being post hoc and not prespecified.…”

Section: Discussionsupporting

confidence: 89%

Degree and Timing of Intensive Blood Pressure Lowering on Hematoma Growth in Intracerebral Hemorrhage

Carcel

Wang

Sato

et al. 2016

Stroke

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Background and Purpose— Degree and timing of blood pressure (BP) lowering treatment in relation to hematoma growth were investigated in the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial-2 (INTERACT2). Methods— INTERACT2 was an international clinical trial of intensive (target systolic BP [SBP], <140 mm Hg) versus guideline-recommended (SBP, <180 mm Hg) BP lowering in 2839 patients within 6 hours of spontaneous intracerebral hemorrhage and elevated SBP (150–220 mm Hg), in which 964 had repeat cranial computed tomography at 24 hours. ANCOVA models assessed categories of SBP reduction and time to target SBP on 24-hour hematoma growth. Results— Greater SBP reduction was associated with reduced hematoma growth (13.3, 5.0, and 3.0 mL for <10, 10–20, and ≥20 mm Hg, respectively; P trend<0.001). In the intensive treatment group (n=491), the least mean hematoma growth was in patients who achieved target SBP <1 hour (2.6 mL) versus to those in target at 1 to 6 (4.7 mL) and >6 hours (5.4 mL). The smallest mean absolute hematoma growth (2.0 mL) was in those achieving target SBP 5 to 8 times versus 3 to 4 (3.1 mL) and 0 to 2 times (5.2 mL). Conclusions— Intensive BP lowering with greater SBP reduction, which is achieved quickly and maintained consistently, seems to provide protection against hematoma growth for 24 hours. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00716079.

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Section: Discussionsupporting

confidence: 89%

Degree and Timing of Intensive Blood Pressure Lowering on Hematoma Growth in Intracerebral Hemorrhage

Carcel

Wang

Sato

et al. 2016

Stroke

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“…Achieved BP at each follow-up time point is are outlined elsewhere. 17,21,24 The number of participants who were either dead or had major disability (mRS, 3-5) at 90 days was 1504 (53.8%; 336 [12.0%] dead, 1168 [41.8%] major disability). The distribution of the mRS scores in each group for each period is shown in Figure S3.…”

Section: Resultsmentioning

confidence: 99%

Magnitude of Blood Pressure Reduction and Clinical Outcomes in Acute Intracerebral Hemorrhage

et al. 2015

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Abstract-Evidence supports early intensive blood pressure (BP) lowering in acute intracerebral hemorrhage, but uncertainty persists over whether potential benefits and harms vary according to the magnitude of BP reduction. We aimed to determine whether larger systolic BP (SBP) reductions were associated with better outcomes in participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). INTERACT2 was an international, open, blinded end point, randomized controlled trial of patients with spontaneous intracerebral hemorrhage (<6 hours) and elevated SBP (150-220 mm Hg) assigned to intensive (target SBP <140 mm Hg) or guideline-recommended (SBP <180 mm Hg) treatment. Associations of BP reduction (baseline minus average of achieved SBP) during 3 time periods post randomization (15-60 minutes, 1-24 hours, and 2-7 days) on poor outcome (death or major disability) at 90 days were analyzed in multivariable logistic regression models with odds ratios and 95% confidence intervals. Larger SBP reductions within the first hour after randomization were associated with lower risks of poor outcome: compared with minimal reduction (<10 mm Hg), odds ratios were 0.80 (95% confidence interval, 0.63-1.02) for moderate (10-20 mm Hg) and 0.65 (0.52-0.82) for large (≥20 mm Hg) reductions (P trend <0.01). Similar associations were also observed for SBP reductions during 1 to 24 hours (P<0.01) and 2 to 7 days (P 0.02). No heterogeneity in associations for patients above or below baseline SBP 180 mm Hg was reported (P>0.30). Optimal recovery from intracerebral hemorrhage was observed in hypertensive patients who achieved the greatest SBP reductions (≥20 mm Hg) in the first hour and maintained for 7 days. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00716079.

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“…Unfortunately, so far the optimal range of blood pressure in the early stage has not been established 2 18 19. Anderson et al 18 reported that intensively lowering blood pressure with a target systolic level of <140 mm Hg within 1 hour did not result in a significant reduction in the rate of death and severe disability but was safe and associated with improved functional outcome.…”

Section: Discussionmentioning

confidence: 99%

Interhospital transfer neurological deterioration in patients with spontaneous intracerebral haemorrhage: incidence and risk factors

Fan

Chen

Yen

et al. 2016

Postgraduate Medical Journal

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Optimal achieved blood pressure in acute intracerebral hemorrhage

Abstract: This study provides Class I evidence that the effect of intensive BP lowering on physical function is not influenced by baseline BP.

Cited by 104 publications

References 23 publications

Degree and Timing of Intensive Blood Pressure Lowering on Hematoma Growth in Intracerebral Hemorrhage

Degree and Timing of Intensive Blood Pressure Lowering on Hematoma Growth in Intracerebral Hemorrhage

Magnitude of Blood Pressure Reduction and Clinical Outcomes in Acute Intracerebral Hemorrhage

Interhospital transfer neurological deterioration in patients with spontaneous intracerebral haemorrhage: incidence and risk factors

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