Outcomes of intensive systolic blood pressure reduction in patients with intracerebral hemorrhage and excessively high initial systolic blood pressure: Post hoc analysis of a randomized clinical trial

By Qureshi AI, Huang W, Lobanova I, et al
Published September 8, 2020

Key Takeaways

In this post hoc analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage-II trial, researchers assessed the differential outcomes of intensive (goal, 110-139 mmHg) vs standard (goal, 140-179 mmHg) systolic blood pressure reduction in patients with intracerebral hemorrhage and initial systolic blood pressure of 220 mmHg or more vs less than 220 mmHg. Included were patients with intracerebral hemorrhage and initial systolic blood pressure of 180 mmHg or higher, randomized within 4.5 hours of symptom onset. In total, 8,532 patients were screened, and 999 people (mean [SD] age, 62.0 [13.1] years; 620 men [62.0%]) underwent randomization and had an initial SBP value. Participants randomized to intensive systolic blood pressure reduction had a significantly higher rate of kidney adverse events but no difference was observed in the rate of kidney serious adverse events. According to results, the higher rate of neurological impairment within 24 hours linked to intensive treatment in patients with intracerebral hemorrhage and initial systolic blood pressure of 220 mmHg or more, with no benefit in minimizing hematoma expansion at 24 hours or death or severe disability at 90 days, warrants caution against the generalization of recommendations for intensive systolic blood pressure decline.

Read the full article on JAMA.

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