Intensive Blood Pressure Reduction is Associated with Reduced Hematoma Growth in Fast Bleeding Intracerebral Hemorrhage A Secondary Analysis of the ATACH-2 Randomized Clinical Trial.
Academic Article
Overview
abstract
OBJECTIVE: Spontaneous intracerebral hemorrhage (ICH) patients at highest risk of hematoma growth are those with the most potential to benefit from anti-expansion treatment. Large clinical trials have not definitively shown a clear benefit of blood pressure (BP) reduction. We aim to determine whether intensive blood pressure reduction could benefit patients with fast bleeding ICH. METHODS: An exploratory analysis of data from the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) randomized controlled trial was performed. In order to capture not just early bleeding (even if a small amount), but the rate of bleeding (mL/hour), we restricted the study to "Fast bleeding ICH," defined as an ICH volume/onset-to-CT time >5mL/hr. Hematoma growth, as defined as an increase of hematoma volume > 33% between baseline and 24 hours. RESULTS: A total of 940 patients were included (mean age 62.1 years, 61.5% male), of whom 214 (22.8%) experienced hematoma expansion. Of these, 567(60.3%) met the definition of "fast bleeding" with baseline ICH volume/time to presentation of at least 5mL/hr. Intensive blood pressure reduction was associated with a significantly lower rate of hematoma growth in fast bleeding patients (20.6% vs 31.0%, p=0.005). In a subgroup of 266 (46.9%) fast-bleeding patients who received treatment within 2 hours after symptom onset, intensive BP lowering was associated with improved functional independence (OR, 1.98; 95% CI,1.06-3.69; p=0.031). INTERPRETATION: Our results suggest that early use of intensive BP reduction may reduce hematoma growth and improve outcome in fast bleeding patients. This article is protected by copyright. All rights reserved.
