Intensive Blood Pressure Lowering in Patients with Moderate to Severe Grade Acute Cerebral Hemorrhage: Post Hoc Analysis of Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH)-2 Trial

摘要

Objective:To study the effect of intensive blood pressure reduction in patients with moderate to severe intracerebral hemorrhage (ICH) within the subjects recruited in Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 trial.Design:Randomized, multicenter, 2 group, open-label clinical trial.Setting:A total of 110 sites in the USA, Japan, China, Taiwan, South Korea, and Germany.Patients:A total of 1,000 patients underwent randomization from May 2011 till September 2015.Interventions:We analyzed the effect of intensive (goal 110-139 mm Hg) over standard (goal 140-179 mm Hg) systolic blood pressure (SBP) reduction using intravenous nicardipine within 4.5 h of symptom onset in moderate to severe grade subjects with ICHin a non-prespecified analysis. Moderate to severe grade was defined by Glasgow Coma Scale score = 10 or baseline intraparenchymal hemorrhage volume >= 30 mL or presence of intraventricular hemorrhage. The primary outcome was death or disability (score 4-6 on the modified Rankin scale) at 3 months after randomization ascertained by a blinded investigator.Measurements and Main Results:Of a total of 682 subjects who met the definition of moderate to severe grade (mean age 61.9 +/- 13.1 years, 62.5% men) with a mean baseline SBP of 174.7 +/- 24.8 mm Hg, thefrequencyof hematoma expansion was significantly lower among subjects randomized to intensive SBP reduction than among subjects randomized to standard SBP reduction (20.4 vs. 27.9%, relative risk [RR]: 0.7; 95% confidence interval [CI]: 0.55-0.96). The primary endpoint of death or disability was observed in 52.5% (170/324) of subjects receiving intensive SBP reduction and 48.9% (163/333) of subjects receiving standard SBP reduction (RR: 1.1; 95% CI: 0.9-1.2).Conclusions:Intensive SBP lowering reduced thefrequencyof hematoma expansion but did not reduce the rate of death or disability in patients with moderate to severe grade ICH.