J-shape relation of blood pressure reduction and outcome in acute intracerebral hemorrhage: A pooled analysis of INTERACT2 and ATACH-II individual participant data

The aim of this study was to better define the shape of association between the degree ("magnitude") of early (< 1 h) reduction in systolic blood pressure (SBP) and outcomes in patients with acute intracerebral hemorrhage (ICH) through pooled analysis of the second Intensive Blood Press...

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Veröffentlicht in:	International journal of stroke Jg. 17; H. 10; S. 1129
Hauptverfasser:	Wang, Xia, Di Tanna, Gian Luca, Moullaali, Tom J, Martin, Renee' H, Shipes, Virginia B, Robinson, Thompson G, Chalmers, John, Suarez, Jose I, Qureshi, Adnan I, Palesch, Yuko Y, Anderson, Craig S
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States 01.12.2022
Schlagworte:	Antihypertensive Agents - therapeutic use Blood Pressure Cerebral Hemorrhage - complications Cerebral Hemorrhage - therapy Female Hematoma Humans Hypertension - drug therapy Middle Aged Stroke Treatment Outcome clinical trial intracerebral hemorrhage Blood pressure acute stroke therapy hypertension stroke
ISSN:	1747-4949, 1747-4949
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Abstract	The aim of this study was to better define the shape of association between the degree ("magnitude") of early (< 1 h) reduction in systolic blood pressure (SBP) and outcomes in patients with acute intracerebral hemorrhage (ICH) through pooled analysis of the second Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) and second Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH-II) datasets. Association of the continuous magnitude of SBP reduction described using cubic splines and an ordinal measure of the functional outcome on the modified Rankin scale (mRS) scores at 90 days were analyzed in generalized linear mixed models. Models were adjusted for achieved (mean) and variability (standard deviation, SD) of SBP between 1 and 24 h, various baseline covariates, and trial as a random effect. Among 3796 patients (mean age 63.1 (SD = 13.0) years; female 37.4%), with a mean magnitude (< 1 h) of SBP reduction of 28.5 (22.8) mmHg, those with larger magnitude were more often non-Asian and female, had higher baseline SBP, received multiple blood pressure (BP) lowering agents, and achieved lower SBP levels in 1-24 h. Compared to those patients with no SBP reduction within 1 h (reference), the adjusted odds of unfavorable functional outcome, according to a shift in mRS scores, were lower for SBP reductions up to 60 mmHg with an inflection point between 32 and 46 mmHg, but significantly higher for SBP reductions > 70 mmHg. Similar J-shape associations were evident across various time epochs across 24 h and consistent according to baseline hematoma volume and SBP and history of hypertension. A moderate degree of rapid SBP lowering is associated with improved functional outcome after ICH, but large SBP reductions over 1 h (e.g. from > 200 to target < 140 mmHg) were associated with reduction, or reversal, of any such benefit.
AbstractList	The aim of this study was to better define the shape of association between the degree ("magnitude") of early (< 1 h) reduction in systolic blood pressure (SBP) and outcomes in patients with acute intracerebral hemorrhage (ICH) through pooled analysis of the second Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) and second Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH-II) datasets. Association of the continuous magnitude of SBP reduction described using cubic splines and an ordinal measure of the functional outcome on the modified Rankin scale (mRS) scores at 90 days were analyzed in generalized linear mixed models. Models were adjusted for achieved (mean) and variability (standard deviation, SD) of SBP between 1 and 24 h, various baseline covariates, and trial as a random effect. Among 3796 patients (mean age 63.1 (SD = 13.0) years; female 37.4%), with a mean magnitude (< 1 h) of SBP reduction of 28.5 (22.8) mmHg, those with larger magnitude were more often non-Asian and female, had higher baseline SBP, received multiple blood pressure (BP) lowering agents, and achieved lower SBP levels in 1-24 h. Compared to those patients with no SBP reduction within 1 h (reference), the adjusted odds of unfavorable functional outcome, according to a shift in mRS scores, were lower for SBP reductions up to 60 mmHg with an inflection point between 32 and 46 mmHg, but significantly higher for SBP reductions > 70 mmHg. Similar J-shape associations were evident across various time epochs across 24 h and consistent according to baseline hematoma volume and SBP and history of hypertension. A moderate degree of rapid SBP lowering is associated with improved functional outcome after ICH, but large SBP reductions over 1 h (e.g. from > 200 to target < 140 mmHg) were associated with reduction, or reversal, of any such benefit. The aim of this study was to better define the shape of association between the degree ("magnitude") of early (< 1 h) reduction in systolic blood pressure (SBP) and outcomes in patients with acute intracerebral hemorrhage (ICH) through pooled analysis of the second Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) and second Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH-II) datasets.OBJECTIVEThe aim of this study was to better define the shape of association between the degree ("magnitude") of early (< 1 h) reduction in systolic blood pressure (SBP) and outcomes in patients with acute intracerebral hemorrhage (ICH) through pooled analysis of the second Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) and second Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH-II) datasets.Association of the continuous magnitude of SBP reduction described using cubic splines and an ordinal measure of the functional outcome on the modified Rankin scale (mRS) scores at 90 days were analyzed in generalized linear mixed models. Models were adjusted for achieved (mean) and variability (standard deviation, SD) of SBP between 1 and 24 h, various baseline covariates, and trial as a random effect.METHODSAssociation of the continuous magnitude of SBP reduction described using cubic splines and an ordinal measure of the functional outcome on the modified Rankin scale (mRS) scores at 90 days were analyzed in generalized linear mixed models. Models were adjusted for achieved (mean) and variability (standard deviation, SD) of SBP between 1 and 24 h, various baseline covariates, and trial as a random effect.Among 3796 patients (mean age 63.1 (SD = 13.0) years; female 37.4%), with a mean magnitude (< 1 h) of SBP reduction of 28.5 (22.8) mmHg, those with larger magnitude were more often non-Asian and female, had higher baseline SBP, received multiple blood pressure (BP) lowering agents, and achieved lower SBP levels in 1-24 h. Compared to those patients with no SBP reduction within 1 h (reference), the adjusted odds of unfavorable functional outcome, according to a shift in mRS scores, were lower for SBP reductions up to 60 mmHg with an inflection point between 32 and 46 mmHg, but significantly higher for SBP reductions > 70 mmHg. Similar J-shape associations were evident across various time epochs across 24 h and consistent according to baseline hematoma volume and SBP and history of hypertension.RESULTSAmong 3796 patients (mean age 63.1 (SD = 13.0) years; female 37.4%), with a mean magnitude (< 1 h) of SBP reduction of 28.5 (22.8) mmHg, those with larger magnitude were more often non-Asian and female, had higher baseline SBP, received multiple blood pressure (BP) lowering agents, and achieved lower SBP levels in 1-24 h. Compared to those patients with no SBP reduction within 1 h (reference), the adjusted odds of unfavorable functional outcome, according to a shift in mRS scores, were lower for SBP reductions up to 60 mmHg with an inflection point between 32 and 46 mmHg, but significantly higher for SBP reductions > 70 mmHg. Similar J-shape associations were evident across various time epochs across 24 h and consistent according to baseline hematoma volume and SBP and history of hypertension.A moderate degree of rapid SBP lowering is associated with improved functional outcome after ICH, but large SBP reductions over 1 h (e.g. from > 200 to target < 140 mmHg) were associated with reduction, or reversal, of any such benefit.INTERPRETATIONA moderate degree of rapid SBP lowering is associated with improved functional outcome after ICH, but large SBP reductions over 1 h (e.g. from > 200 to target < 140 mmHg) were associated with reduction, or reversal, of any such benefit.
Author	Robinson, Thompson G Di Tanna, Gian Luca Moullaali, Tom J Suarez, Jose I Qureshi, Adnan I Shipes, Virginia B Wang, Xia Chalmers, John Anderson, Craig S Martin, Renee' H Palesch, Yuko Y
Author_xml	– sequence: 1 givenname: Xia orcidid: 0000-0002-1684-7076 surname: Wang fullname: Wang, Xia organization: The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia – sequence: 2 givenname: Gian Luca surname: Di Tanna fullname: Di Tanna, Gian Luca organization: The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia – sequence: 3 givenname: Tom J orcidid: 0000-0002-6786-3623 surname: Moullaali fullname: Moullaali, Tom J organization: Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK – sequence: 4 givenname: Renee' H surname: Martin fullname: Martin, Renee' H organization: Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA – sequence: 5 givenname: Virginia B surname: Shipes fullname: Shipes, Virginia B organization: Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA – sequence: 6 givenname: Thompson G surname: Robinson fullname: Robinson, Thompson G organization: National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK – sequence: 7 givenname: John orcidid: 0000-0002-9931-0580 surname: Chalmers fullname: Chalmers, John organization: The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia – sequence: 8 givenname: Jose I surname: Suarez fullname: Suarez, Jose I organization: Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA – sequence: 9 givenname: Adnan I surname: Qureshi fullname: Qureshi, Adnan I organization: Zeenat Qureshi Stroke Institutes and Department of Neurology, University of Missouri, Columbia, MO, USA – sequence: 10 givenname: Yuko Y surname: Palesch fullname: Palesch, Yuko Y organization: Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA – sequence: 11 givenname: Craig S surname: Anderson fullname: Anderson, Craig S organization: The George Institute for Global Health, Peking University Health Science Center, Beijing, China
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SubjectTerms	Antihypertensive Agents - therapeutic use Blood Pressure Cerebral Hemorrhage - complications Cerebral Hemorrhage - therapy Female Hematoma Humans Hypertension - drug therapy Middle Aged Stroke Treatment Outcome
Title	J-shape relation of blood pressure reduction and outcome in acute intracerebral hemorrhage: A pooled analysis of INTERACT2 and ATACH-II individual participant data
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