Ultra-Early Blood Pressure Reduction Attenuates Hematoma Growth and Improves Outcome in Intracerebral Hemorrhage.
Ultra-Early Blood Pressure Reduction Attenuates Hematoma Growth and Improves Outcome in Intracerebral Hemorrhage.
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超早期降低血压可减轻脑出血患者的血肿增长并改善预后。
DOI：
10.1002/ana.25793
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发表时间：
2020-08
影响因子：
11.2
通讯作者：
Goldstein JN
中科院分区：
文献类型：
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作者：
Li Q;Warren AD;Qureshi AI;Morotti A;Falcone GJ;Sheth KN;Shoamanesh A;Dowlatshahi D;Viswanathan A;Goldstein JN
目的是调查在症状出现后 2 小时内接受静脉尼卡地平治疗的脑出血 (ICH) 患者中，强化血压治疗是否与血肿生长减少和更好的预后相关。对急性脑出血抗高血压治疗 2 (ATACH-2) 试验进行了事后探索性分析。这是一项多中心、国际、开放标签、随机临床试验，原发性脑出血患者在症状出现后 4.5 小时内被分配接受尼卡地平强化治疗与标准降压治疗。在本次分析中，我们纳入了 913 名具有完整影像学和随访数据的患者。在 913 名患者中，354 名（38.7%）在 2 小时内开始静脉尼卡地平治疗。在2小时内接受治疗的这一亚组患者中，强化降压组的ICH扩张频率显着低于标准治疗组（p = 0.02）。多变量分析显示，超早期强化血压治疗与血肿生长风险降低（比值比，0.56；95%置信区间[CI]，0.34-0.92；p = 0.02）、较高的功能独立率（比值比，2.17；95% CI，1.28-3.68；p = 0.004）和良好的预后相关。 90 天时（比值比，1.68；95% CI，1.01–2.83；p = 0.048）。超早期强化降压与 3 个月时改良 Rankin 量表评分分布的有利变化相关（p = 0.04）。在血压升高的 ICH 患者亚组中，在症状出现后 ≤2 小时内静脉注射尼卡地平，强化血压降低与血肿生长减少和功能结果改善相关。
The aim was to investigate whether intensive blood pressure treatment is associated with less hematoma growth and better outcome in intracerebral hemorrhage (ICH) patients who received intravenous nicardipine treatment ≤2 hours after onset of symptoms. A post-hoc exploratory analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) trial was performed. This was a multicenter, international, open-label, randomized clinical trial, in which patients with primary ICH were allocated to intensive versus standard blood pressure treatment with nicardipine ≤4.5 hours after onset of symptoms. We have included 913 patients with complete imaging and follow-up data in the present analysis. Among the 913 included patients, 354 (38.7%) had intravenous nicardipine treatment initiated within 2 hours. In this subgroup of patients treated within 2 hours, the frequency of ICH expansion was significantly lower in the intensive blood pressure reduction group compared with the standard treatment group (p = 0.02). Multivariable analysis showed that ultra-early intensive blood pressure treatment was associated with a decreased risk of hematoma growth (odds ratio, 0.56; 95% confidence interval [CI], 0.34–0.92; p = 0.02), higher rate of functional independence (odds ratio, 2.17; 95% CI, 1.28–3.68; p = 0.004), and good outcome (odds ratio, 1.68; 95% CI, 1.01–2.83; p = 0.048) at 90 days. Ultra-early intensive blood pressure reduction was associated with a favorable shift in modified Rankin Scale score distribution at 3 months (p = 0.04). In a subgroup of ICH patients with elevated blood pressure given intravenous nicardipine ≤2 hours after onset of symptoms, intensive blood pressure reduction was associated with reduced hematoma growth and improved functional outcome.
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DOI：
10.1056/nejmoa1603460
发表时间：
2016-09-15
期刊：
The New England journal of medicine
影响因子：
--
作者：
Qureshi AI;Palesch YY;Barsan WG;Hanley DF;Hsu CY;Martin RL;Moy CS;Silbergleit R;Steiner T;Suarez JI;Toyoda K;Wang Y;Yamamoto H;Yoon BW;ATACH-2 Trial Investigators and the Neurological Emergency Treatment Trials Network
通讯作者：
ATACH-2 Trial Investigators and the Neurological Emergency Treatment Trials Network
影响因子：
9.9
作者：
Maas, Matthew B.;Nemeth, Alexander J.;Naidech, Andrew M.
通讯作者：
Naidech, Andrew M.
影响因子：
158.5
作者：
Mayer, Stephan A.;Brun, Nikolai C.;Steiner, Thorsten
通讯作者：
Steiner, Thorsten
影响因子：
9.9
作者：
Goldstein, J. N.;Fazen, L. E.;Rosand, J.
通讯作者：
Rosand, J.
影响因子：
168.9
作者：
Qureshi, Adnan I.;Mendelow, A. David;Hanley, Daniel F.
通讯作者：
Hanley, Daniel F.