Clinical outcomes depending on acute blood pressure after cerebral hemorrhage

Abstract

Objective

To determine the association between clinical outcomes and acute systolic blood pressure (SBP) levels achieved after intracerebral hemorrhage (ICH).

Methods

Eligible patients who were randomized to the Antihypertensive Treatment in Intracerebral Hemorrhage 2 (ATACH‐2) trial (ClinicalTrials.gov NCT01176565) were divided into 5 groups by 10‐mmHg strata of average hourly minimum SBP (<120 mmHg, 120‐130, 130‐140, 140‐150 and ≥150) during 2 to 24 hours after randomization. Outcomes included: 90‐day modified Rankin Scale (mRS) 4‐6; hematoma expansion, defined as an increase ≥6 mL from baseline to 24‐hour computed tomography; and cardio‐renal adverse events within 7 days.

Results

Of the 1,000 subjects in ATACH‐2, 995 with available SBP data were included in the analyses. The proportion of mRS 4‐6 was 37.5%, 36.0%, 42.8%, 38.6%, and 38.0%, respectively. For the '140‐150' group relative to the '120‐130', the odds ratio, adjusting for sex, race, age, onset‐to‐randomization time, baseline National Institutes of Health Stroke Scale score, hematoma volume, and hematoma location, was 1.62 (95% confidence interval 1.02‐2.58). Hematoma expansion was identified in 16.9%, 13.7%, 21.4%, 18.5%, and 26.4%, respectively. The '140‐150' (odds ratio 1.80, 95% confidence interval 1.05‐3.09) and '≥150' (1.98, 1.12‐3.51) showed a higher frequency of expansion than '120‐130' group. Cardio‐renal events occurred in 13.6%, 16.6%, 11.5%, 8.1%, and 8.2%, respectively. The '140‐150' (0.43, 0.19‐0.88) and '≥150' (0.44, 0.18‐0.96) showed a lower frequency of the events than the '120‐130'.

Interpretation

Beneficial effects of lowering and maintaining SBP at 120‐130 mmHg during the first 24 hours on clinical outcomes by suppressing hematoma expansion was somewhat offset by cardio‐renal complications.

This article is protected by copyright. All rights reserved.

https://ift.tt/2OGU78e