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

So we still have NO FUCKING CLUE what a blood pressure management protocol is. Hope you don't mind dying because of the cesspools of incompetence of the complete stroke medical world.  Unless YOU hold your stroke hospital's feet to the fire you are allowing your children and grandchildren to die or become disabled.

 

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

Xia Wanghttps://orcid.org/0000-0002-1684-70761, Gian Luca Di Tanna1, Tom J Moullaalihttps://orcid.org/0000-0002-6786-36231,2, Renee’ H Martin3, Virginia B Shipes3, Thompson G Robinson4,5, John Chalmershttps://orcid.org/0000-0002-9931-05801, Jose I Suarez6, Adnan I Qureshi7, Yuko Y Palesch3, and Craig S Anderson1,8,9
 

Objective: 

 

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.
 

Methods: 

 

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.
 

Results:

 

 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.
 

Interpretation: 

 

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.
Keywords
Blood pressure, intracerebral hemorrhage, acute stroke therapy, clinical trial, hypertension, stroke
1The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
2Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
3Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
4Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
5National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
6Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
7Zeenat Qureshi Stroke Institutes and Department of Neurology, University of Missouri, Columbia, MO, USA
8Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, NSW, Australia
9The George Institute for Global Health, Peking University Health Science Center, Beijing, China
Corresponding author(s):
Craig S Anderson, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, P.O. Box M201, Camperdown, Sydney, NSW 2050, Australia. Email: canderson@georgeinstitute.org.au