Regional Differences in the Response to Acute Blood Pressure Lowering After Cerebral Hemorrhage
| Autor: | Lydia D. Foster, Yasuhiro Hasegawa, Shuhei Okazaki, Kenji Kamiyama, Masatoshi Koga, Masafumi Ihara, Kazunori Toyoda, Byung-Woo Yoon, Kanta Tanaka, Yongjun Wang, Toru Iwama, Sohei Yoshimura, Chung Y. Hsu, Yuko Y. Palesch, Yoshiaki Shiokawa, Thorsten Steiner, Adnan I Qureshi, Haruko Yamamoto, Kaori Miwa, Mayumi Fukuda-Doi, Haruhiko Hoshino |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty China Taiwan Article Patient Care Planning White People law.invention 03 medical and health sciences Nicardipine 0302 clinical medicine Hematoma Randomized controlled trial Asian People Japan law Modified Rankin Scale Internal medicine Germany Republic of Korea medicine Humans 030212 general & internal medicine Adverse effect Antihypertensive Agents Aged Cerebral Hemorrhage Intracerebral hemorrhage business.industry Standard treatment Middle Aged medicine.disease United States Black or African American Blood pressure Treatment Outcome Relative risk Disease Progression Female Neurology (clinical) business Tomography X-Ray Computed 030217 neurology & neurosurgery |
| Zdroj: | Neurology article-version (Version of Record) 3 |
| ISSN: | 1526-632X 0028-3878 |
| Popis: | Objective:To compare the impact of intensive blood pressure (BP) lowering right after intracerebral hemorrhage (ICH) on clinical and hematoma outcomes among patients from different geographic locations, we performed a prespecified sub-analysis of the randomized, multi-national, two-group, open-label trial to determine the efficacy of rapidly lowering BP in hyperacute ICH (ATACH-2), involving 537 patients from East Asia and 463 recruited outside of Asia.Methods:Eligible patients were randomly assigned to a systolic BP (SBP) target of 110-139 mmHg (intensive treatment) or 140-179 mmHg (standard treatment). Pre-defined outcomes were: poor functional outcome (modified Rankin Scale score of 4-6 at 90 days), death within 90 days, hematoma expansion at 24 hours; and cardio-renal adverse events within 7 days.Results:Poor functional outcomes (32.0% versus 45.9%), death (1.9% versus 13.3%), and cardio-renal adverse events (3.9% versus 11.2%) occurred significantly less in patients from Asia than those outside of Asia. The treatment-by-cohort interaction was not significant for any outcomes. Only patients from Asia showed a lower incidence of hematoma expansion with intensive treatment (adjusted RR 0.56, 95% CI 0.38-0.83). Both Asian (3.53, 1.28-9.64) and non-Asian cohorts (1.71, 1.00-2.93) showed a higher incidence of cardio-renal adverse events with intensive treatment.Conclusions:Poor functional outcomes and death 90 days after ICH were less common in patients from East Asia than those outside of Asia. Hematoma expansion, a potential predictor for poor clinical outcome, was attenuated by intensive BP lowering only in the Asian cohort.Clinicaltrials.gov identifierNCT01176565.Classification of evidence:This study provides Class II evidence that, for patients from East Asia with intracerebral hemorrhage, intensive blood pressure lowering significantly reduces the risk of hematoma expansion. |
| Databáze: | OpenAIRE |
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