Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage

• Type: Article in International Scientific Journal
• Date: 2013

Authors

Anderson, CS (Author) Other; Heeley, E (Author) Other; Huang, Y (Author) Other; Wang, J (Author) Other; Stapf, C (Author) Other; Delcourt, C (Author) Other; Lindley, R (Author) Other; Robinson, T (Author) Other; Lavados, P (Author) Other; Neal, B (Author) Other; Hata, J (Author) Other; Arima, H (Author) Other; Parsons, M (Author) Other; Li, Y (Author) Other; Wang, J (Author) Other; Heritier, S (Author) Other; Li, Q (Author) Other; Woodward, M (Author) Other; Simes, RJ (Author) Other; Davis, SM (Author) Other; Chalmers, J (Author) Other; Elsa Azevedo (Author) FMUP

Journal

Title: New England Journal of Medicine

Vol. 368

Pages: 2355-2365

ISSN: 0028-4793

Publisher: Massachusetts Medical Society

Indexing

Scopus - 1223 Citations

Other information

Authenticus ID: P-008-PQM

DOI: 10.1056/nejmoa1214609

Abstract (EN): BACKGROUND: Whether rapid lowering of elevated blood pressure would improve the outcome in patients with intracerebral hemorrhage is not known. METHODS: We randomly assigned 2839 patients who had had a spontaneous intracerebral hemorrhage within the previous 6 hours and who had elevated systolic blood pressure to receive intensive treatment to lower their blood pressure (with a target systolic level of <140 mm Hg within 1 hour) or guideline-recommended treatment (with a target systolic level of <180 mm Hg) with the use of agents of the physician's choosing. The primary outcome was death or major disability, which was defined as a score of 3 to 6 on the modified Rankin scale (in which a score of 0 indicates no symptoms, a score of 5 indicates severe disability, and a score of 6 indicates death) at 90 days. A prespecified ordinal analysis of the modified Rankin score was also performed. The rate of serious adverse events was compared between the two groups. RESULTS: Among the 2794 participants for whom the primary outcome could be determined, 719 of 1382 participants (52.0%) receiving intensive treatment, as compared with 785 of 1412 (55.6%) receiving guideline-recommended treatment, had a primary outcome event (odds ratio with intensive treatment, 0.87; 95% confidence interval [CI], 0.75 to 1.01; P = 0.06). The ordinal analysis showed significantly lower modified Rankin scores with intensive treatment (odds ratio for greater disability, 0.87; 95% CI, 0.77 to 1.00; P = 0.04). Mortality was 11.9% in the group receiving intensive treatment and 12.0% in the group receiving guideline-recommended treatment. Nonfatal serious adverse events occurred in 23.3% and 23.6% of the patients in the two groups, respectively. CONCLUSIONS: In patients with intracerebral hemorrhage, intensive lowering of blood pressure did not result in a significant reduction in the rate of the primary outcome of death or severe disability. An ordinal analysis of modified Rankin scores indicated improved functional outcomes with intensive lowering of blood pressure. (Funded by the National Health and Medical Research Council of Australia; INTERACT2 ClinicalTrials.gov number, NCT00716079.) Copyright © 2013 Massachusetts Medical Society.

Language: English

Type (Professor's evaluation): Scientific