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Intensive Blood Pressure Reduction and Perihematomal Edema Expansion in Deep Intracerebral Hemorrhage.

TitleIntensive Blood Pressure Reduction and Perihematomal Edema Expansion in Deep Intracerebral Hemorrhage.
Publication TypeJournal Article
Year of Publication2019
AuthorsLeasure AC, Qureshi AI, Murthy SB, Kamel H, Goldstein JN, Walsh KB, Woo D, Shi F-D, Huttner HB, Ziai WC, Hanley DF, Matouk CC, Sansing LH, Falcone GJ, Sheth KN
JournalStroke
Volume50
Issue8
Pagination2016-2022
Date Published2019 08
ISSN1524-4628
KeywordsAged, Antihypertensive Agents, Brain Edema, Female, Humans, Intracranial Hemorrhage, Hypertensive, Male, Middle Aged, Multicenter Studies as Topic, Nicardipine, Randomized Controlled Trials as Topic, Retrospective Studies
Abstract

Background and Purpose- It is unknown whether blood pressure (BP) reduction influences secondary brain injury in spontaneous intracerebral hemorrhage (ICH). We tested the hypothesis that intensive BP reduction is associated with decreased perihematomal edema expansion rate (PHER) in deep ICH. Methods- We performed an exploratory analysis of the ATACH-2 randomized trial (Antihypertensive Treatment of Acute Cerebral Hemorrhage-2). Patients with deep, supratentorial ICH were included. PHER was calculated as the difference in perihematomal edema volume between baseline and 24-hour computed tomography scans divided by hours between scans. We used regression analyses to determine whether intensive BP reduction was associated with PHER and if PHER was associated with poor outcome (3-month modified Rankin Scale score 4-6). We then used interaction analyses to test whether specific deep location (basal ganglia versus thalamus) modified these associations. Results- Among 1000 patients enrolled in ATACH-2, 870 (87%) had supratentorial, deep ICH. Of these, 780 (90%) had neuroimaging data (336 thalamic and 444 basal ganglia hemorrhages). Baseline characteristics of the treatment groups remained balanced (P>0.2). Intensive BP reduction was associated with a decrease in PHER in univariable (β= -0.15; 95% CI, -0.26 to -0.05; P=0.007) and multivariable (β=-0.12; 95% CI, -0.21 to -0.02; P=0.03) analyses. PHER was not independently associated with outcome in all deep ICH (odds ratio, 1.14; 95% CI, 0.93-1.41; P=0.20), but this association was modified by the specific deep location involved (multivariable interaction P=0.02); in adjusted analyses, PHER was associated with poor outcome in basal ganglia (odds ratio, 1.42; 1.05-1.97; P=0.03) but not thalamic (odds ratio, 1.02; 95% CI, 0.74-1.40; P=0.89) ICH. Conclusions- Intensive BP reduction was associated with decreased 24-hour PHER in deep ICH. PHER was not independently associated with outcome in all deep ICH but was associated with poor outcome in basal ganglia ICH. PHER may be a clinically relevant end point for clinical trials in basal ganglia ICH.

DOI10.1161/STROKEAHA.119.024838
Alternate JournalStroke
PubMed ID31272326
PubMed Central IDPMC6646091
Grant ListR01 NR018335 / NR / NINR NIH HHS / United States
U01 NS080824 / NS / NINDS NIH HHS / United States
U24 NS107136 / NS / NINDS NIH HHS / United States
P30 AG021342 / AG / NIA NIH HHS / United States
UL1 TR001863 / TR / NCATS NIH HHS / United States
U01 NS095869 / NS / NINDS NIH HHS / United States
K23 NS082367 / NS / NINDS NIH HHS / United States
R03 NS112859 / NS / NINDS NIH HHS / United States
R01 NS095993 / NS / NINDS NIH HHS / United States
K23 NS105948 / NS / NINDS NIH HHS / United States
K76 AG059992 / AG / NIA NIH HHS / United States
R01 NS097443 / NS / NINDS NIH HHS / United States
R01 NS102583 / NS / NINDS NIH HHS / United States
T35 HL007649 / HL / NHLBI NIH HHS / United States
R01 NS097728 / NS / NINDS NIH HHS / United States
U24 NS107215 / NS / NINDS NIH HHS / United States
U24 TR001609 / TR / NCATS NIH HHS / United States
U01 NS106513 / NS / NINDS NIH HHS / United States

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