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Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage

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Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. / Anderson, Craig S; Heeley, Emma; Huang, Yining; Wang, Jiguang; Stapf, Christian; Delcourt, Candice; Lindley, Richard; Robinson, Thompson; Lavados, Pablo; Neal, Bruce; Hata, Jun; Arima, Hisatomi; Parsons, Mark; Li, Yuechun; Wang, Jinchao; Heritier, Stephane; Li, Qiang; Woodward, Mark; Simes, R John; Davis, Stephen M; Chalmers, John; INTERACT2 investigators.

In: NEW ENGL J MED, Vol. 368, No. 25, 20.06.2013, p. 2355-65.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Anderson, CS, Heeley, E, Huang, Y, Wang, J, Stapf, C, Delcourt, C, Lindley, R, Robinson, T, Lavados, P, Neal, B, Hata, J, Arima, H, Parsons, M, Li, Y, Wang, J, Heritier, S, Li, Q, Woodward, M, Simes, RJ, Davis, SM, Chalmers, J & INTERACT2 investigators 2013, 'Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage', NEW ENGL J MED, vol. 368, no. 25, pp. 2355-65. https://doi.org/10.1056/NEJMoa1214609

APA

Anderson, C. S., Heeley, E., Huang, Y., Wang, J., Stapf, C., Delcourt, C., Lindley, R., Robinson, T., Lavados, P., Neal, B., Hata, J., Arima, H., Parsons, M., Li, Y., Wang, J., Heritier, S., Li, Q., Woodward, M., Simes, R. J., ... INTERACT2 investigators (2013). Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. NEW ENGL J MED, 368(25), 2355-65. https://doi.org/10.1056/NEJMoa1214609

Vancouver

Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. NEW ENGL J MED. 2013 Jun 20;368(25):2355-65. https://doi.org/10.1056/NEJMoa1214609

Bibtex

@article{9de32b8359d74f4884ab006e7ec29aac,
title = "Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage",
abstract = "BACKGROUND: Whether rapid lowering of elevated blood pressure would improve the outcome in patients with intracerebral hemorrhage is not known.METHODS: We randomly assigned 2839 patients who had had a spontaneous intracerebral hemorrhage within the previous 6 hours and who had elevated systolic blood pressure to receive intensive treatment to lower their blood pressure (with a target systolic level of <140 mm Hg within 1 hour) or guideline-recommended treatment (with a target systolic level of <180 mm Hg) with the use of agents of the physician's choosing. The primary outcome was death or major disability, which was defined as a score of 3 to 6 on the modified Rankin scale (in which a score of 0 indicates no symptoms, a score of 5 indicates severe disability, and a score of 6 indicates death) at 90 days. A prespecified ordinal analysis of the modified Rankin score was also performed. The rate of serious adverse events was compared between the two groups.RESULTS: Among the 2794 participants for whom the primary outcome could be determined, 719 of 1382 participants (52.0%) receiving intensive treatment, as compared with 785 of 1412 (55.6%) receiving guideline-recommended treatment, had a primary outcome event (odds ratio with intensive treatment, 0.87; 95% confidence interval [CI], 0.75 to 1.01; P=0.06). The ordinal analysis showed significantly lower modified Rankin scores with intensive treatment (odds ratio for greater disability, 0.87; 95% CI, 0.77 to 1.00; P=0.04). Mortality was 11.9% in the group receiving intensive treatment and 12.0% in the group receiving guideline-recommended treatment. Nonfatal serious adverse events occurred in 23.3% and 23.6% of the patients in the two groups, respectively.CONCLUSIONS: In patients with intracerebral hemorrhage, intensive lowering of blood pressure did not result in a significant reduction in the rate of the primary outcome of death or severe disability. An ordinal analysis of modified Rankin scores indicated improved functional outcomes with intensive lowering of blood pressure. (Funded by the National Health and Medical Research Council of Australia; INTERACT2 ClinicalTrials.gov number, NCT00716079.).",
keywords = "Acute Disease, Aged, Antihypertensive Agents, Blood Pressure, Cerebral Hemorrhage, Disability Evaluation, Female, Humans, Hypertension, Male, Middle Aged, Single-Blind Method, Time Factors",
author = "Anderson, {Craig S} and Emma Heeley and Yining Huang and Jiguang Wang and Christian Stapf and Candice Delcourt and Richard Lindley and Thompson Robinson and Pablo Lavados and Bruce Neal and Jun Hata and Hisatomi Arima and Mark Parsons and Yuechun Li and Jinchao Wang and Stephane Heritier and Qiang Li and Mark Woodward and Simes, {R John} and Davis, {Stephen M} and John Chalmers and {INTERACT2 investigators} and G{\"o}tz Thomalla",
year = "2013",
month = jun,
day = "20",
doi = "10.1056/NEJMoa1214609",
language = "English",
volume = "368",
pages = "2355--65",
journal = "NEW ENGL J MED",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "25",

}

RIS

TY - JOUR

T1 - Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage

AU - Anderson, Craig S

AU - Heeley, Emma

AU - Huang, Yining

AU - Wang, Jiguang

AU - Stapf, Christian

AU - Delcourt, Candice

AU - Lindley, Richard

AU - Robinson, Thompson

AU - Lavados, Pablo

AU - Neal, Bruce

AU - Hata, Jun

AU - Arima, Hisatomi

AU - Parsons, Mark

AU - Li, Yuechun

AU - Wang, Jinchao

AU - Heritier, Stephane

AU - Li, Qiang

AU - Woodward, Mark

AU - Simes, R John

AU - Davis, Stephen M

AU - Chalmers, John

AU - INTERACT2 investigators

AU - Thomalla, Götz

PY - 2013/6/20

Y1 - 2013/6/20

N2 - BACKGROUND: Whether rapid lowering of elevated blood pressure would improve the outcome in patients with intracerebral hemorrhage is not known.METHODS: We randomly assigned 2839 patients who had had a spontaneous intracerebral hemorrhage within the previous 6 hours and who had elevated systolic blood pressure to receive intensive treatment to lower their blood pressure (with a target systolic level of <140 mm Hg within 1 hour) or guideline-recommended treatment (with a target systolic level of <180 mm Hg) with the use of agents of the physician's choosing. The primary outcome was death or major disability, which was defined as a score of 3 to 6 on the modified Rankin scale (in which a score of 0 indicates no symptoms, a score of 5 indicates severe disability, and a score of 6 indicates death) at 90 days. A prespecified ordinal analysis of the modified Rankin score was also performed. The rate of serious adverse events was compared between the two groups.RESULTS: Among the 2794 participants for whom the primary outcome could be determined, 719 of 1382 participants (52.0%) receiving intensive treatment, as compared with 785 of 1412 (55.6%) receiving guideline-recommended treatment, had a primary outcome event (odds ratio with intensive treatment, 0.87; 95% confidence interval [CI], 0.75 to 1.01; P=0.06). The ordinal analysis showed significantly lower modified Rankin scores with intensive treatment (odds ratio for greater disability, 0.87; 95% CI, 0.77 to 1.00; P=0.04). Mortality was 11.9% in the group receiving intensive treatment and 12.0% in the group receiving guideline-recommended treatment. Nonfatal serious adverse events occurred in 23.3% and 23.6% of the patients in the two groups, respectively.CONCLUSIONS: In patients with intracerebral hemorrhage, intensive lowering of blood pressure did not result in a significant reduction in the rate of the primary outcome of death or severe disability. An ordinal analysis of modified Rankin scores indicated improved functional outcomes with intensive lowering of blood pressure. (Funded by the National Health and Medical Research Council of Australia; INTERACT2 ClinicalTrials.gov number, NCT00716079.).

AB - BACKGROUND: Whether rapid lowering of elevated blood pressure would improve the outcome in patients with intracerebral hemorrhage is not known.METHODS: We randomly assigned 2839 patients who had had a spontaneous intracerebral hemorrhage within the previous 6 hours and who had elevated systolic blood pressure to receive intensive treatment to lower their blood pressure (with a target systolic level of <140 mm Hg within 1 hour) or guideline-recommended treatment (with a target systolic level of <180 mm Hg) with the use of agents of the physician's choosing. The primary outcome was death or major disability, which was defined as a score of 3 to 6 on the modified Rankin scale (in which a score of 0 indicates no symptoms, a score of 5 indicates severe disability, and a score of 6 indicates death) at 90 days. A prespecified ordinal analysis of the modified Rankin score was also performed. The rate of serious adverse events was compared between the two groups.RESULTS: Among the 2794 participants for whom the primary outcome could be determined, 719 of 1382 participants (52.0%) receiving intensive treatment, as compared with 785 of 1412 (55.6%) receiving guideline-recommended treatment, had a primary outcome event (odds ratio with intensive treatment, 0.87; 95% confidence interval [CI], 0.75 to 1.01; P=0.06). The ordinal analysis showed significantly lower modified Rankin scores with intensive treatment (odds ratio for greater disability, 0.87; 95% CI, 0.77 to 1.00; P=0.04). Mortality was 11.9% in the group receiving intensive treatment and 12.0% in the group receiving guideline-recommended treatment. Nonfatal serious adverse events occurred in 23.3% and 23.6% of the patients in the two groups, respectively.CONCLUSIONS: In patients with intracerebral hemorrhage, intensive lowering of blood pressure did not result in a significant reduction in the rate of the primary outcome of death or severe disability. An ordinal analysis of modified Rankin scores indicated improved functional outcomes with intensive lowering of blood pressure. (Funded by the National Health and Medical Research Council of Australia; INTERACT2 ClinicalTrials.gov number, NCT00716079.).

KW - Acute Disease

KW - Aged

KW - Antihypertensive Agents

KW - Blood Pressure

KW - Cerebral Hemorrhage

KW - Disability Evaluation

KW - Female

KW - Humans

KW - Hypertension

KW - Male

KW - Middle Aged

KW - Single-Blind Method

KW - Time Factors

U2 - 10.1056/NEJMoa1214609

DO - 10.1056/NEJMoa1214609

M3 - SCORING: Journal article

C2 - 23713578

VL - 368

SP - 2355

EP - 2365

JO - NEW ENGL J MED

JF - NEW ENGL J MED

SN - 0028-4793

IS - 25

ER -