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- Title
Ultra-Early Blood Pressure Reduction Attenuates Hematoma Growth and Improves Outcome in Intracerebral Hemorrhage.
- Authors
Li, Qi; Warren, Andrew D.; Qureshi, Adnan I.; Morotti, Andrea; Falcone, Guido J.; Sheth, Kevin N.; Shoamanesh, Ashkan; Dowlatshahi, Dar; Viswanathan, Anand; Goldstein, Joshua N.
- Abstract
<bold>Objective: </bold>The aim was to investigate whether intensive blood pressure treatment is associated with less hematoma growth and better outcome in intracerebral hemorrhage (ICH) patients who received intravenous nicardipine treatment ≤2 hours after onset of symptoms.<bold>Methods: </bold>A post-hoc exploratory analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) trial was performed. This was a multicenter, international, open-label, randomized clinical trial, in which patients with primary ICH were allocated to intensive versus standard blood pressure treatment with nicardipine ≤4.5 hours after onset of symptoms. We have included 913 patients with complete imaging and follow-up data in the present analysis.<bold>Results: </bold>Among the 913 included patients, 354 (38.7%) had intravenous nicardipine treatment initiated within 2 hours. In this subgroup of patients treated within 2 hours, the frequency of ICH expansion was significantly lower in the intensive blood pressure reduction group compared with the standard treatment group (p = 0.02). Multivariable analysis showed that ultra-early intensive blood pressure treatment was associated with a decreased risk of hematoma growth (odds ratio, 0.56; 95% confidence interval [CI], 0.34-0.92; p = 0.02), higher rate of functional independence (odds ratio, 2.17; 95% CI, 1.28-3.68; p = 0.004), and good outcome (odds ratio, 1.68; 95% CI, 1.01-2.83; p = 0.048) at 90 days. Ultra-early intensive blood pressure reduction was associated with a favorable shift in modified Rankin Scale score distribution at 3 months (p = 0.04).<bold>Interpretation: </bold>In a subgroup of ICH patients with elevated blood pressure given intravenous nicardipine ≤2 hours after onset of symptoms, intensive blood pressure reduction was associated with reduced hematoma growth and improved functional outcome. ANN NEUROL 2020;88:388-395.
- Subjects
INTRACEREBRAL hematoma; BLOOD pressure; CEREBRAL hemorrhage; HYPOTENSION; SYMPTOMS; PRESSURE groups; ANTIHYPERTENSIVE agents; RESEARCH; HEMATOMA; INTRAVENOUS therapy; RESEARCH methodology; MEDICAL care; PATIENTS; EVALUATION research; MEDICAL cooperation; TREATMENT effectiveness; COMPARATIVE studies; RANDOMIZED controlled trials
- Publication
Annals of Neurology, 2020, Vol 88, Issue 2, p388
- ISSN
0364-5134
- Publication type
journal article
- DOI
10.1002/ana.25793