Rapid Blood Pressure Lowering According to Recovery at Different Time Intervals after Acute Intracerebral Hemorrhage: Pooled Analysis of the INTERACT Studies

2015 ◽  
Vol 39 (3-4) ◽  
pp. 242-248 ◽  
Author(s):  
Xia Wang ◽  
Hisatomi Arima ◽  
Rustam Al-Shahi Salman ◽  
Mark Woodward ◽  
Emma Heeley ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Repeated Measures ◽  
Treatment Effects ◽  
Blood Pressure Reduction ◽  
Pooled Analysis ◽  
Clinical Trial Registration ◽  
Acute Intracerebral Hemorrhage ◽  
Time Periods ◽  
Intensive Blood Pressure

Background and Purpose: Early intensive blood pressure (BP) lowering has been shown to improve functional outcome in acute intracerebral hemorrhage (ICH), but the treatment effect is modest and without a clearly defined underlying explanatory mechanism. We aimed at more reliably quantifying the benefits of this treatment according to different time periods in the recovery of participants in the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) studies. Methods: Pooled analysis of the pilot INTERACT1 (n = 404) and main INTERACT2 (n = 2,839) involving patients with spontaneous ICH (<6 h) and elevated systolic BP (SBP 150-220 mm Hg) who were randomized to intensive (target SBP <140 mm Hg) or guideline-recommended (target SBP <180 mm Hg) BP lowering treatment. Treatment effects were examined according to repeated measures analysis of an ordinal (‘shift') across all 7 levels of the modified Rankin Scale (mRS) assessed during follow-up at 7, 28, and 90 days, post-randomization. Clinical trial registration information: http://www.clinicaltrials.gov, NCT00226096 and NCT00716079. Results: Intensive BP lowering resulted in a significant favorable distribution of mRS scores for better functioning (odds ratio 1.13, 95% confidence interval 1.00-1.26; p = 0.042) over 7, 28 and 90 days, and the effect was consistency for early (7-28 days) and later (28-90 days) time periods (p homogeneity 0.353). Treatment effects were also consistent across several pre-specified patient characteristic subgroups, with trends favoring those randomized early, and with higher SBP and milder neurological severity at baseline. Conclusions: Intensive BP lowering provides beneficial effects on physical functioning that manifests consistently through the early and later phases of recovery from ICH.

Intensive blood pressure reduction in acute intracerebral hemorrhage: A meta-analysis

Neurology ◽  
2014 ◽  
Vol 83 (17) ◽  
pp. 1523-1529 ◽  
Author(s):  
G. Tsivgoulis ◽  
A. H. Katsanos ◽  
K. S. Butcher ◽  
E. Boviatsis ◽  
N. Triantafyllou ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Meta Analysis ◽  
Blood Pressure Reduction ◽  
Pressure Reduction ◽  
Acute Intracerebral Hemorrhage ◽  
Intensive Blood Pressure

Intensive blood pressure reduction in acute intracerebral hemorrhage: A meta-analysis

Neurology ◽  
2015 ◽  
Vol 84 (24) ◽  
pp. 2464-2465 ◽  
Author(s):  
G. Tsivgoulis ◽  
A. H. Katsanos ◽  
R. Behrouz ◽  
S. Hafeez ◽  
S. A. Mutgi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Meta Analysis ◽  
Blood Pressure Reduction ◽  
Pressure Reduction ◽  
Acute Intracerebral Hemorrhage ◽  
Intensive Blood Pressure

scholarly journals Evolution of blood pressure management in acute intracerebral hemorrhage

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 2035 ◽  
Author(s):  
Stacy Chu ◽  
Lauren Sansing
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Blood Pressure Reduction ◽  
Large Body ◽  
Pressure Reduction ◽  
Pressure Management ◽  
Risks And Benefits ◽  
Blood Pressure Management ◽  
Acute Intracerebral Hemorrhage ◽  
Intensive Blood Pressure

Intracerebral hemorrhage (ICH) remains a prevalent and severe cause of death and disability worldwide. Control of the hypertensive response in acute ICH has been a mainstay of ICH management, yet the optimal approaches and the yield of recommended strategies have been difficult to establish despite a large body of literature. Over the years, theoretical and observed risks and benefits of intensive blood pressure reduction in ICH have been studied in the form of animal models, radiographic studies, and two recent large, randomized patient trials. In this article, we review the historical and developing data and discuss remaining questions surrounding blood pressure management in acute ICH.

scholarly journals Early Blood Pressure Lowering Does Not Reduce Growth of Intraventricular Hemorrhage following Acute Intracerebral Hemorrhage: Results of the INTERACT Studies

2016 ◽  
Vol 6 (3) ◽  
pp. 71-75 ◽  
Author(s):  
Edward Chan ◽  
Craig S. Anderson ◽  
Xia Wang ◽  
Hisatomi Arima ◽  
Anubhav Saxena ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Intraventricular Hemorrhage ◽  
Blood Pressure Reduction ◽  
Analysis Of Covariance ◽  
Significant Difference ◽  
Pressure Lowering ◽  
Acute Intracerebral Hemorrhage ◽  
Growth Methods ◽  
Intensive Blood Pressure

Background: Intraventricular hemorrhage (IVH) extension is common following acute intracerebral hemorrhage (ICH) and is associated with poor prognosis. Aim: To determine whether intensive blood pressure (BP)-lowering therapy reduces IVH growth. Methods: Pooled analyses of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials (INTERACT1 and INTERACT2) computed tomography (CT) substudies; multicenter, open, controlled, randomized trials of patients with acute spontaneous ICH and elevated systolic BP, randomly assigned to intensive (<140 mm Hg) or guideline-based (<180 mm Hg) BP management. Participants had blinded central analyses of baseline and 24-hour CT. Association of BP lowering to IVH growth was assessed in analysis of covariance. Results: There was no significant difference in adjusted mean IVH growth following intensive (n = 228) compared to guideline-recommended (n = 228) BP treatment (1.6 versus 2.2 ml, respectively; p = 0.56). Adjusted mean IVH growth was nonsignificantly greater in patients with a mean achieved systolic BP ≥160 mm Hg over 24 h (3.94 ml; p trend = 0.26). Conclusions: Early intensive BP-lowering treatment had no clear effect on IVH in acute ICH.

J-shape relation of blood pressure reduction and outcome in acute intracerebral hemorrhage: A pooled analysis of INTERACT2 and ATACH-II individual participant data

2022 ◽  
pp. 174749302110640
Author(s):  
Xia Wang ◽  
Gian Luca Di Tanna ◽  
Tom J Moullaali ◽  
Renee’ H Martin ◽  
Virginia B Shipes ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Cerebral Hemorrhage ◽  
Blood Pressure Reduction ◽  
Random Effect ◽  
Pooled Analysis ◽  
Moderate Degree ◽  
Pressure Reduction ◽  
Acute Intracerebral Hemorrhage

Objective: The aim of this study was to better define the shape of association between the degree (“magnitude”) of early (< 1 h) reduction in systolic blood pressure (SBP) and outcomes in patients with acute intracerebral hemorrhage (ICH) through pooled analysis of the second Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) and second Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH-II) datasets. Methods: Association of the continuous magnitude of SBP reduction described using cubic splines and an ordinal measure of the functional outcome on the modified Rankin scale (mRS) scores at 90 days were analyzed in generalized linear mixed models. Models were adjusted for achieved (mean) and variability (standard deviation, SD) of SBP between 1 and 24 h, various baseline covariates, and trial as a random effect. Results: Among 3796 patients (mean age 63.1 (SD = 13.0) years; female 37.4%), with a mean magnitude (< 1 h) of SBP reduction of 28.5 (22.8) mmHg, those with larger magnitude were more often non-Asian and female, had higher baseline SBP, received multiple blood pressure (BP) lowering agents, and achieved lower SBP levels in 1–24 h. Compared to those patients with no SBP reduction within 1 h (reference), the adjusted odds of unfavorable functional outcome, according to a shift in mRS scores, were lower for SBP reductions up to 60 mmHg with an inflection point between 32 and 46 mmHg, but significantly higher for SBP reductions > 70 mmHg. Similar J-shape associations were evident across various time epochs across 24 h and consistent according to baseline hematoma volume and SBP and history of hypertension. Interpretation: A moderate degree of rapid SBP lowering is associated with improved functional outcome after ICH, but large SBP reductions over 1 h (e.g. from > 200 to target < 140 mmHg) were associated with reduction, or reversal, of any such benefit.

Abstract 215: Does the CT Angiography Spot Sign Identify Intracerebral Hemorrhage Patients More Likely to Benefit From Intensive Blood Pressure Reduction?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Andrea Morotti ◽  
Bart H Brouwers ◽  
Javier M Romero ◽  
Michael J Jessel ◽  
Anastasia Vashkevich ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Strong Predictor ◽  
Blood Pressure Reduction ◽  
Standard Group ◽  
Inclusion Criteria ◽  
Multivariable Logistic Regression Model ◽  
Spot Sign ◽  
Intensive Blood Pressure

Background and Purpose: the computed tomography angiography (CTA) spot sign is a strong predictor of intracerebral hemorrhage (ICH) expansion, and may mark those most likely to benefit from intensive blood pressure (BP) reduction. The Spot Sign score in restricting ICH growth (SCORE-IT) study analyzed whether intensive BP reduction improved outcome in Spot Sign positive patients enrolled in the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2) clinical trial. Methods: In ATACH-2, patients with ICH were randomly assigned to intensive (systolic BP target: 110-139 mmHg) versus standard (systolic BP target: 140-179 mmHg) BP treatment within 4.5 h from stroke onset. This analysis included patients with a CTA performed within 8 hours from onset. The association between intensive BP lowering, ICH expansion and functional outcome was investigated with a multivariable logistic regression model. Results: 133 subjects met the inclusion criteria, of whom 53 (39.9%) had a spot sign and 24/123 (19.5%) experienced ICH expansion. A total of 56/123 patients had a 90 day modified Rankin scale (mRS) >3 (45.5%). Among Spot positive patients, 74.1% of those in the intensive BP lowering group had poor outcome, compared with 50.0% of those in the standard group (p=0.31). After adjustment for potential confounders, intensive BP lowering was not associated with a significant reduction of ICH expansion (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.27 - 2.51, p = 0.74) or improved functional outcome (OR for mRS>3 1.24, 95% CI 0.53 - 2.91, p = 0.62) in spot sign positive ICH patients. Conclusions: We found no evidence that ICH patients with a spot sign specifically benefit from intensive BP reduction.

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