Blood pressure-attained analysis of ATACH 2 trial

Adnan I. Qureshi, Yuko Y. Palesch, Lydia D. Foster, William G. Barsan, Joshua N. Goldstein, Daniel F. Hanley, Chung Y. Hsu, Claudia S. Moy, Mushtaq H. Qureshi, Robert Silbergleit, Jose I. Suarez, Kazunori Toyoda, Haruko Yamamoto

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Purpose-We compared the rates of death or disability, defined by modified Rankin Scale score of 4 to 6, at 3 months in patients with intracerebral hemorrhage according to post-treatment systolic blood pressure (SBP)-attained status. Methods-We divided 1000 subjects with SBP ≥180 mm Hg who were randomized within 4.5 hours of symptom onset as follows: SBP <140 mm Hg achieved or not achieved within 2 hours; subjects in whom SBP <140 mm Hg was achieved within 2 hours were further divided: SBP <140 mm Hg for 21 to 22 hours (reduced and maintained) or SBP was ≥140 mm Hg for at least 2 hours during the period between 2 and 24 hours (reduced but not maintained). Results-Compared with subjects without reduction of SBP <140 mm Hg within 2 hours, subjects with reduction and maintenance of SBP <140 mm Hg within 2 hours had a similar rate of death or disability (relative risk of 0.98; 95% confidence interval, 0.74-1.29). The rates of neurological deterioration within 24 hours were significantly higher in reduced and maintained group (10.4%; relative risk, 1.98; 95% confidence interval, 1.08-3.62) and in reduced but not maintained group (11.5%; relative risk, 2.08; 95% confidence interval, 1.15-3.75) compared with reference group. The rates of cardiac-related adverse events within 7 days were higher among subjects with reduction and maintenance of SBP <140 mmHg compared to subjects without reduction (11.2% versus 6.4%). Conclusions-No decline in death or disability but higher rates of neurological deterioration and cardiac-related adverse events were observed among intracerebral hemorrhage subjects with reduction with and without maintenance of intensive SBP goals.

Original languageEnglish (US)
Pages (from-to)1412-1418
Number of pages7
JournalStroke
Volume49
Issue number6
DOIs
StatePublished - 2018
Externally publishedYes

Keywords

  • acute hypertensive response
  • blood pressure
  • cerebral hemorrhage
  • clinical trial
  • humans

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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