TY - JOUR T1 - Intensive Blood Pressure Lowering in Patients with Moderate to Severe Grade Acute Cerebral Hemorrhage: Post Hoc Analysis of Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH)-2 Trial. AU - Qureshi,Adnan I, AU - Foster,Lydia D, AU - Lobanova,Iryna, AU - Huang,Wei, AU - Suarez,Jose I, Y1 - 2020/06/25/ PY - 2019/11/05/received PY - 2020/02/04/accepted PY - 2020/6/26/pubmed PY - 2020/12/1/medline PY - 2020/6/26/entrez KW - Clinical trial KW - Death or disability KW - Hematoma expansion KW - Intracerebral hemorrhage KW - Systolic blood pressure SP - 244 EP - 252 JF - Cerebrovascular diseases (Basel, Switzerland) JO - Cerebrovasc Dis VL - 49 IS - 3 N2 - OBJECTIVE: To study the effect of intensive blood pressure reduction in patients with moderate to severe intracerebral hemorrhage (ICH) within the subjects recruited in Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 trial. DESIGN: Randomized, multicenter, 2 group, open-label clinical trial. SETTING: A total of 110 sites in the USA, Japan, China, Taiwan, South Korea, and Germany. PATIENTS: A total of 1,000 patients underwent randomization from May 2011 till September 2015. INTERVENTIONS: We analyzed the effect of intensive (goal 110-139 mm Hg) over standard (goal 140-179 mm Hg) systolic blood pressure (SBP) reduction using intravenous nicardipine within 4.5 h of symptom onset in moderate to severe grade subjects with ICH in a non-prespecified analysis. Moderate to severe grade was defined by Glasgow Coma Scale score <13 or baseline National Institutes of Health Stroke Scale score ≥10 or baseline intraparenchymal hemorrhage volume ≥30 mL or presence of intraventricular hemorrhage. The primary outcome was death or disability (score 4-6 on the modified Rankin scale) at 3 months after randomization ascertained by a blinded investigator. MEASUREMENTS AND MAIN RESULTS: Of a total of 682 subjects who met the definition of moderate to severe grade (mean age 61.9 ± 13.1 years, 62.5% men) with a mean baseline SBP of 174.7 ± 24.8 mm Hg, the frequency of hematoma expansion was significantly lower among subjects randomized to intensive SBP reduction than among subjects randomized to standard SBP reduction (20.4 vs. 27.9%, relative risk [RR]: 0.7; 95% confidence interval [CI]: 0.55-0.96). The primary endpoint of death or disability was observed in 52.5% (170/324) of subjects receiving intensive SBP reduction and 48.9% (163/333) of subjects receiving standard SBP reduction (RR: 1.1; 95% CI: 0.9-1.2). CONCLUSIONS: Intensive SBP lowering reduced the frequency of hematoma expansion but did not reduce the rate of death or disability in patients with moderate to severe grade ICH. SN - 1421-9786 UR - https://www.unboundmedicine.com/medline/citation/32585668/Intensive_Blood_Pressure_Lowering_in_Patients_with_Moderate_to_Severe_Grade_Acute_Cerebral_Hemorrhage:_Post_Hoc_Analysis_of_Antihypertensive_Treatment_of_Acute_Cerebral_Hemorrhage__ATACH__2_Trial_ DB - PRIME DP - Unbound Medicine ER -