biostudies-literatureQureshi AIIntramural NIH HHSNINDS NIH HHS1033-43https://www.ebi.ac.uk/biostudies/studies/S-EPMC5345109biostudies-literatureUnknown375(11)<h4>Background</h4>Limited data are available to guide the choice of a target for the systolic blood-pressure level when treating acute hypertensive response in patients with intracerebral hemorrhage.<h4>Methods</h4>We randomly assigned eligible participants with intracerebral hemorrhage (volume, <60 cm(3)) and a Glasgow Coma Scale (GCS) score of 5 or more (on a scale from 3 to 15, with lower scores indicating worse condition) to a systolic blood-pressure target of 110 to 139 mm Hg (intensive treatment) or a target of 140 to 179 mm Hg (standard treatment) in order to test the superiority of intensive reduction of systolic blood pressure to standard reduction; intravenous nicardipine to lower blood pressure was administered within 4.5 hours after symptom onset. The primary outcome was death or disability (modified Rankin scale score of 4 to 6, on a scale ranging from 0 [no symptoms] to 6 [death]) at 3 months after randomization, as ascertained by an investigator who was unaware of the treatment assignments.<h4>Results</h4>Among 1000 participants with a mean (±SD) systolic blood pressure of 200.6±27.0 mm Hg at baseline, 500 were assigned to intensive treatment and 500 to standard treatment. The mean age of the patients was 61.9 years, and 56.2% were Asian. Enrollment was stopped because of futility after a prespecified interim analysis. The primary outcome of death or disability was observed in 38.7% of the participants (186 of 481) in the intensive-treatment group and in 37.7% (181 of 480) in the standard-treatment group (relative risk, 1.04; 95% confidence interval, 0.85 to 1.27; analysis was adjusted for age, initial GCS score, and presence or absence of intraventricular hemorrhage). Serious adverse events occurring within 72 hours after randomization that were considered by the site investigator to be related to treatment were reported in 1.6% of the patients in the intensive-treatment group and in 1.2% of those in the standard-treatment group. The rate of renal adverse events within 7 days after randomization was significantly higher in the intensive-treatment group than in the standard-treatment group (9.0% vs. 4.0%, P=0.002).<h4>Conclusions</h4>The treatment of participants with intracerebral hemorrhage to achieve a target systolic blood pressure of 110 to 139 mm Hg did not result in a lower rate of death or disability than standard reduction to a target of 140 to 179 mm Hg. (Funded by the National Institute of Neurological Disorders and Stroke and the National Cerebral and Cardiovascular Center; ATACH-2 ClinicalTrials.gov number, NCT01176565 .).The New England journal of medicineIntensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage.PMC5345109U01 NS059041U01 NS056975U01-NS056975U01 NS061861U01-NS062091U01-NS059041U01 NS062091U01-NS061861U10 NS086484U10 NS058927Aufderheide TPetty BChern CMDillon CBambakidis NZucharello MBerry-Hymon SSuh SChae YJVisweswaran AKalugdan VSLollar SXu NMendoza-Moore MSantos GFazio PWang YTWarrick MMNovak AMiller KHenry ACassarly CChaudhry SAKoga MVenkatasubramanian CZeller JSun MCBarsan WMcNelis PMLaine AYoon BMiller CThomas-Dodson SHays ANLieu KSilbergleit RMatsukami MOhta YLuke SBrion BBurns JDTorii MKunnakkat SDCruz-Floes SSpeiser JSato SQuinn JGreer DMMiller ZTsai LKHudock DJones LBFrance KBostroem AAfshinnik AYe KFurui EMcNamara KAgarwal SLee IYHelms AQureshi AITseng LTKidwell CSZacko JChen YChiba MKennedy EChen QCarter TChen JNakamura KTakenoshita SGuresir ESpencer AGarcia MPanezai SNakamura AStaugaitis AAltschul DReddy VItoh YFalo MAbe TWhatmore DNLiu CLRitter SJLamond KNagatsuka KBarton LYoo DDechtenberg LWitzel CGreeley LHirase KSanghera TMurphy STang SCMerritt LSergot PBConnelly BGentile NTHartman LSanchez OMeeker MJickling GCHightower BDuRoss AKrell KEGoldstein JNBrau LJColston KStasinski GSabir RAhmed IYoshihira SATACH-2 Trial Investigators and the Neurological Emergency Treatment Trials NetworkHsu JPTitus MRamirez AMFroehler MTMoy CHobohm CDeyampert AMahmood APettigrew LCVelasquez AHall AJRzesiewicz TRen XLedger Evon Eberstein AMKeene KRWijman CAnyanwu BMann RRose DZKimura KGuillen MNganongo WICaceres AJStanek MTBae HJChang ILichti MCGaines KMalkoff MOkamoto MBlack JHsueh YFLevine SRVan Huysen CYeh HLCallahan RTran HBasobas LDenes JBiros MNeeper LHoh BLRapp KSidorov EAkins AChopskie ERech NFujii RSuarez JILien LMDunalewicz SHoshino HFatar MSethi PToyoda KAlexandrov AVSisson AHenning RHanley DFDeCarvalho BFreeman BZubkov AYKaji YGamble DHasegawa YValsamis HSen SJo JYSakai NYanny LDifiore SJeng JSTirrell GFreese MASwor RTorbey MCarmody CWeingast SZCallaway CWTakahashi SHalliday JRMohamed WBarnhart BMiller JBKulstad ELau HIbrahim MSShah BDas ESmith WGebel JMAudebert CHRibitsch MShiokawa YJerde AOhara HPatel NLowenkopf TKatz AFilla-Taylor JEgashira YMcBee NGallatti NWright DMcCormick RSuri MFHsiao PMBehrouz RSeidel‐Glatzer AUhegwu NGaenslen AThornley AHu EKase CSLewandowski CLin DZiemann UKirshner HSHsiao PJKhanna ABusinger PStevenson VZhao WMayer SAJones EWewerka SBaren JMaud AHesse KIwama TKelly NPorbeni CFreeman WMesse SWartenberg KEEpple CCohen AChang TRShibazaki KBranoff MGrundman BHarbison WBarsan WGMcTigue TMa HIBushey MMartin RLCalvillo ETakagi TRodriguez GJRahim BPeters TShhadeh AClasen KMika VHowell MUschmann HJonczak KFisk PMaeda KReimer HBoyer CLi JMeyer DBergman TAOkuda SChen CHLi YTodo KDiFiore SZhong LHsu CTSuzuki MCarhuapoma JHedna VSHsu CYHsu CWLo YKFrance KARichter HKnapp KNorris GMChou SLovick DKirmani JFSeder DBHolzemer MUeda TOkazaki SHoffman DMarriott EHartig FThomas JKRenault SShah QARiker RRClaassen JPradilla GBosel JThompson BBLaw SWAbbott EILele AYoon BWNabhan STrabert JJanis SMcCann PMerck LHBerlet UFukuda-Doi MHemphill JMaland ETKamiyama KMartin RDenninghoff KBankston MBeck PLundell AMShah JJRittenberger JCEl Khoury RWelch RNovitzke JMYoshimura SVaughan KMcCrum BFSteiner TDikovytska BHsu YTHenderson GFeeback JWFlugel AKMiley JTClark SZwank MDBallew ACaveney ALee MPalmieri KKim JMartin-Schild SOsanai ASpeers MHerale DHara TEdwards EHussein HNishijima DKUrban DBengelink EPalesch YYConner CThiessen RSchumacher HCQureshi MHLee YMays-Wilson KHumphries RWussow TBrown AKnoll KMoy CSMichalski DCarroll JWang DSeidl SKhatri RParides MKChavez RBrown DWhitaker LFoster LAfzal MRHassan AEWang YWang ZSimonis CGarland EYamamoto HPark JRemmel KSYeh SJLunney MPMerkin RIwuchukwu IEhtisham AHo EOttman MBittner ALodi YMRodriguez MVatter HKizza RChase-Gregory CEmiru TMolyneaux BJKunze KDing ZPoli SLin CHMischel EEller SLerch JLaChance LShort JOkada AArmbuster KEbner MArnedo VLachance LHarsh DOkada YArakawa CCwiklinski VStell AMika VHBrown SMena MfalseIntensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage.<h4>Background</h4>Limited data are available to guide the choice of a target for the systolic blood-pressure level when treating acute hypertensive response in patients with intracerebral hemorrhage.<h4>Methods</h4>We randomly assigned eligible participants with intracerebral hemorrhage (volume, <60 cm(3)) and a Glasgow Coma Scale (GCS) score of 5 or more (on a scale from 3 to 15, with lower scores indicating worse condition) to a systolic blood-pressure target of 110 to 139 mm Hg (intensive treatment) or a target of 140 to 179 mm Hg (standard treatment) in order to test the superiority of intensive reduction of systolic blood pressure to standard reduction; intravenous nicardipine to lower blood pressure was administered within 4.5 hours after symptom onset. The primary outcome was death or disability (modified Rankin scale score of 4 to 6, on a scale ranging from 0 [no symptoms] to 6 [death]) at 3 months after randomization, as ascertained by an investigator who was unaware of the treatment assignments.<h4>Results</h4>Among 1000 participants with a mean (±SD) systolic blood pressure of 200.6±27.0 mm Hg at baseline, 500 were assigned to intensive treatment and 500 to standard treatment. The mean age of the patients was 61.9 years, and 56.2% were Asian. Enrollment was stopped because of futility after a prespecified interim analysis. The primary outcome of death or disability was observed in 38.7% of the participants (186 of 481) in the intensive-treatment group and in 37.7% (181 of 480) in the standard-treatment group (relative risk, 1.04; 95% confidence interval, 0.85 to 1.27; analysis was adjusted for age, initial GCS score, and presence or absence of intraventricular hemorrhage). Serious adverse events occurring within 72 hours after randomization that were considered by the site investigator to be related to treatment were reported in 1.6% of the patients in the intensive-treatment group and in 1.2% of those in the standard-treatment group. The rate of renal adverse events within 7 days after randomization was significantly higher in the intensive-treatment group than in the standard-treatment group (9.0% vs. 4.0%, P=0.002).<h4>Conclusions</h4>The treatment of participants with intracerebral hemorrhage to achieve a target systolic blood pressure of 110 to 139 mm Hg did not result in a lower rate of death or disability than standard reduction to a target of 140 to 179 mm Hg. (Funded by the National Institute of Neurological Disorders and Stroke and the National Cerebral and Cardiovascular Center; ATACH-2 ClinicalTrials.gov number, NCT01176565 .).2016-01-01T00:00:00Z2016 Sep2024-10-18T20:02:11.442Z2019-03-27T02:38:22ZS-EPMC53451092727623410.1056/nejmoa160346010.1056/NEJMoa1603460