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. 2018 Jun;49(6):1412-1418.
doi: 10.1161/STROKEAHA.117.019845. Epub 2018 May 22.

Blood Pressure-Attained Analysis of ATACH 2 Trial

Adnan I Qureshi  1 , Yuko Y Palesch  2 , Lydia D Foster  2 , William G Barsan  3 , Joshua N Goldstein  4 , Daniel F Hanley  5 , Chung Y Hsu  6 , Claudia S Moy  7 , Mushtaq H Qureshi  8 , Robert Silbergleit  3 , Jose I Suarez  9 , Kazunori Toyoda  10 , Haruko Yamamoto  10 ; ATACH 2 Trial Investigators
Affiliations

Blood Pressure-Attained Analysis of ATACH 2 Trial

Adnan I Qureshi et al. Stroke. 2018 Jun.

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.

Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01176565.

Keywords: acute hypertensive response; blood pressure; cerebral hemorrhage; clinical trial; humans.

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Figures

Figure 1.
Figure 1.
Systolic blood profile for 24 h post-randomization according to blood pressure-attained groups.
Figure 2.
Figure 2.
Outcomes in blood pressure-attained groups. RR indicates relative risk.
See this image and copyright information in PMC

References

    1. Qureshi AI, Suri MF, Nasar A, Kirmani JF, Ezzeddine MA, Divani AA, et al. Changes in cost and outcome among US patients with stroke hospitalized in 1990 to 1991 and those hospitalized in 2000 to 2001. Stroke. 2007;38:2180–2184. doi: 10.1161/STROKEAHA.106.467506. - DOI - PubMed
    1. Qureshi AI. The importance of acute hypertensive response in ICH. Stroke. 2013;44(6 suppl 1):S67–S69. doi: 10.1161/STROKEAHA.111.000758. - DOI - PubMed
    1. Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C, et al.; INTERACT2 Investigators. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013;368:2355–2365. doi: 10.1056/NEJMoa1214609. - DOI - PubMed
    1. Qureshi AI, Palesch YY, Barsan WG, Hanley DF, Hsu CY, Martin RL, et al.; ATACH-2 Trial Investigators and the Neurological Emergency Treatment Trials Network. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med. 2016;375:1033–1043. doi: 10.1056/NEJMoa1603460. - DOI - PMC - PubMed
    1. Qureshi AI, Hutson AD, Harbaugh RE, Stieg PE, Hopkins LN; North American Trial of Unruptured and Ruptured Aneurysms Planning Committee. Methods and design considerations for randomized clinical trials evaluating surgical or endovascular treatments for cerebrovascular diseases. Neurosurgery. 2004;54:248–264; discussion 264-247. - PubMed

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