Intensive Blood Pressure Lowering in Intracerebral Hemorrhage.
Intensive Blood Pressure Lowering in Intracerebral Hemorrhage.
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DOI：
10.1161/strokeaha.117.016185
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发表时间：
2017-07
期刊：
影响因子：
8.3
通讯作者：
Qureshi AI
中科院分区：
文献类型：
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作者：
Anderson CS;Selim MH;Molina CA;Qureshi AI
Anderson等人在ICH 2035中的血压降低很少有INTERACT2参与者在陈述时有这种水平的SBP。其次，ATACH-II参与者接受静脉注射尼卡地平，而INTERACT2参与者根据局部可获得性接受一系列静脉和口服降压药。第三，强化治疗中达到的平均最低SBP(<；130 mm Hg)和停止静脉降压治疗时的血压水平(<；110 mm Hg)，ATACH-I组比INTERACT2组低。INTERACT2的子分析表明，脑出血的最佳预后与24小时平均SBP达到130至139毫米汞柱有关，但SBP<；130毫米汞的不良预后略有增加。5这些差异表明，对SBP非常高的脑出血患者进行非常迅速和密集的SBP治疗(目标为130毫米汞柱)可能会抵消任何潜在的好处。随后对随机试验进行的荟萃分析，以及手术患者强化降压的额外信息，6进一步证实了安全性，并显示了一种引人注目的趋势，即早期强化降压对脑出血的益处，以及对最合理的、机械性替代血肿生长终点的显著影响。7.
Anderson et al BP Lowering in ICH 2035 few INTERACT2 participants had this level of SBP at presentation. Second, ATACH-II participants were administered intravenous nicardipine, whereas INTERACT2 participants received a range of intravenous and oral BP-lowering agents based on local availability. Third, the achieved mean minimum SBP (< 130 mm Hg) in the intensive treatment and BP level (< 110 mm Hg) for cessation of intravenous BP-lowering treatment were lower in ATACH-I compared with INTERACT2. A subanalysis of INTERACT2 indicates that the best outcome from ICH is related to an achieved mean SBP of 130 to 139 mm Hg over 24 hours, but a modest increase in poor outcome was suggested at SBP< 130 mm Hg. 5 These differences imply that very rapid and intensive SBP treatment (target< 130 mm Hg) for ICH patients with very high SBP could negate any potential benefits. Subsequent meta-analysis of randomized trials, and additional information of intensive BP lowering in surgical patients, 6 provides further confirmation of safety and a compelling trend toward a benefit of early intensive BP lowering in ICH, supported by a significant effect on the most plausible, mechanistic surrogate end point of hematoma growth. 7