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Rapid Blood Pressure Lowering According to Recovery at Different Time Intervals after Acute Intracerebral Hemorrhage: Pooled Analysis of the INTERACT Studies

Background and Purpose: Early intensive blood pressure (BP) lowering has been shown to improve functional outcome in acute intracerebral hemorrhage (ICH), but the treatment effect is modest and without a clearly defined underlying explanatory mechanism. We aimed at more reliably quantifying the bene... Full description

Journal Title: Cerebrovascular diseases (Basel Switzerland), 2015-04, Vol.39 (3-4), p.242-248
Main Author: Wang, Xia
Other Authors: Arima, Hisatomi , Al-Shahi Salman, Rustam , Woodward, Mark , Heeley, Emma , Stapf, Christian , Lavados, Pablo M , Robinson, Thompson , Huang, Yining , Wang, Jiguang , Delcourt, Candice , Anderson, Craig S
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: Basel, Switzerland: S. Karger AG
ID: ISSN: 1015-9770
Link: https://www.ncbi.nlm.nih.gov/pubmed/25823544
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recordid: cdi_pubmed_primary_25823544
title: Rapid Blood Pressure Lowering According to Recovery at Different Time Intervals after Acute Intracerebral Hemorrhage: Pooled Analysis of the INTERACT Studies
format: Article
creator:
  • Wang, Xia
  • Arima, Hisatomi
  • Al-Shahi Salman, Rustam
  • Woodward, Mark
  • Heeley, Emma
  • Stapf, Christian
  • Lavados, Pablo M
  • Robinson, Thompson
  • Huang, Yining
  • Wang, Jiguang
  • Delcourt, Candice
  • Anderson, Craig S
subjects:
  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Analysis
  • Blood pressure
  • Blood Pressure - physiology
  • Cerebral Hemorrhage - complications
  • Cerebral Hemorrhage - therapy
  • Female
  • Humans
  • Hypotension - etiology
  • Hypotension - physiopathology
  • Intracerebral hemorrhage
  • Male
  • Middle Aged
  • Original Paper
  • Time Factors
  • Treatment Outcome
ispartof: Cerebrovascular diseases (Basel, Switzerland), 2015-04, Vol.39 (3-4), p.242-248
description: Background and Purpose: Early intensive blood pressure (BP) lowering has been shown to improve functional outcome in acute intracerebral hemorrhage (ICH), but the treatment effect is modest and without a clearly defined underlying explanatory mechanism. We aimed at more reliably quantifying the benefits of this treatment according to different time periods in the recovery of participants in the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) studies. Methods: Pooled analysis of the pilot INTERACT1 (n = 404) and main INTERACT2 (n = 2,839) involving patients with spontaneous ICH (
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 1015-9770
fulltext: fulltext
issn:
  • 1015-9770
  • 1421-9786
url: Link


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titleRapid Blood Pressure Lowering According to Recovery at Different Time Intervals after Acute Intracerebral Hemorrhage: Pooled Analysis of the INTERACT Studies
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creatorWang, Xia ; Arima, Hisatomi ; Al-Shahi Salman, Rustam ; Woodward, Mark ; Heeley, Emma ; Stapf, Christian ; Lavados, Pablo M ; Robinson, Thompson ; Huang, Yining ; Wang, Jiguang ; Delcourt, Candice ; Anderson, Craig S
creatorcontribWang, Xia ; Arima, Hisatomi ; Al-Shahi Salman, Rustam ; Woodward, Mark ; Heeley, Emma ; Stapf, Christian ; Lavados, Pablo M ; Robinson, Thompson ; Huang, Yining ; Wang, Jiguang ; Delcourt, Candice ; Anderson, Craig S ; for the INTERACT Investigators
descriptionBackground and Purpose: Early intensive blood pressure (BP) lowering has been shown to improve functional outcome in acute intracerebral hemorrhage (ICH), but the treatment effect is modest and without a clearly defined underlying explanatory mechanism. We aimed at more reliably quantifying the benefits of this treatment according to different time periods in the recovery of participants in the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) studies. Methods: Pooled analysis of the pilot INTERACT1 (n = 404) and main INTERACT2 (n = 2,839) involving patients with spontaneous ICH (<6 h) and elevated systolic BP (SBP 150-220 mm Hg) who were randomized to intensive (target SBP <140 mm Hg) or guideline-recommended (target SBP <180 mm Hg) BP lowering treatment. Treatment effects were examined according to repeated measures analysis of an ordinal (‘shift') across all 7 levels of the modified Rankin Scale (mRS) assessed during follow-up at 7, 28, and 90 days, post-randomization. Clinical trial registration information: http://www.clinicaltrials.gov, NCT00226096 and NCT00716079. Results: Intensive BP lowering resulted in a significant favorable distribution of mRS scores for better functioning (odds ratio 1.13, 95% confidence interval 1.00-1.26; p = 0.042) over 7, 28 and 90 days, and the effect was consistency for early (7-28 days) and later (28-90 days) time periods (p homogeneity 0.353). Treatment effects were also consistent across several pre-specified patient characteristic subgroups, with trends favoring those randomized early, and with higher SBP and milder neurological severity at baseline. Conclusions: Intensive BP lowering provides beneficial effects on physical functioning that manifests consistently through the early and later phases of recovery from ICH.
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subjectAcute Disease ; Adult ; Aged ; Aged, 80 and over ; Analysis ; Blood pressure ; Blood Pressure - physiology ; Cerebral Hemorrhage - complications ; Cerebral Hemorrhage - therapy ; Female ; Humans ; Hypotension - etiology ; Hypotension - physiopathology ; Intracerebral hemorrhage ; Male ; Middle Aged ; Original Paper ; Time Factors ; Treatment Outcome
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descriptionBackground and Purpose: Early intensive blood pressure (BP) lowering has been shown to improve functional outcome in acute intracerebral hemorrhage (ICH), but the treatment effect is modest and without a clearly defined underlying explanatory mechanism. We aimed at more reliably quantifying the benefits of this treatment according to different time periods in the recovery of participants in the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) studies. Methods: Pooled analysis of the pilot INTERACT1 (n = 404) and main INTERACT2 (n = 2,839) involving patients with spontaneous ICH (<6 h) and elevated systolic BP (SBP 150-220 mm Hg) who were randomized to intensive (target SBP <140 mm Hg) or guideline-recommended (target SBP <180 mm Hg) BP lowering treatment. Treatment effects were examined according to repeated measures analysis of an ordinal (‘shift') across all 7 levels of the modified Rankin Scale (mRS) assessed during follow-up at 7, 28, and 90 days, post-randomization. Clinical trial registration information: http://www.clinicaltrials.gov, NCT00226096 and NCT00716079. Results: Intensive BP lowering resulted in a significant favorable distribution of mRS scores for better functioning (odds ratio 1.13, 95% confidence interval 1.00-1.26; p = 0.042) over 7, 28 and 90 days, and the effect was consistency for early (7-28 days) and later (28-90 days) time periods (p homogeneity 0.353). Treatment effects were also consistent across several pre-specified patient characteristic subgroups, with trends favoring those randomized early, and with higher SBP and milder neurological severity at baseline. Conclusions: Intensive BP lowering provides beneficial effects on physical functioning that manifests consistently through the early and later phases of recovery from ICH.
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titleRapid Blood Pressure Lowering According to Recovery at Different Time Intervals after Acute Intracerebral Hemorrhage: Pooled Analysis of the INTERACT Studies
authorWang, Xia ; Arima, Hisatomi ; Al-Shahi Salman, Rustam ; Woodward, Mark ; Heeley, Emma ; Stapf, Christian ; Lavados, Pablo M ; Robinson, Thompson ; Huang, Yining ; Wang, Jiguang ; Delcourt, Candice ; Anderson, Craig S
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abstractBackground and Purpose: Early intensive blood pressure (BP) lowering has been shown to improve functional outcome in acute intracerebral hemorrhage (ICH), but the treatment effect is modest and without a clearly defined underlying explanatory mechanism. We aimed at more reliably quantifying the benefits of this treatment according to different time periods in the recovery of participants in the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) studies. Methods: Pooled analysis of the pilot INTERACT1 (n = 404) and main INTERACT2 (n = 2,839) involving patients with spontaneous ICH (<6 h) and elevated systolic BP (SBP 150-220 mm Hg) who were randomized to intensive (target SBP <140 mm Hg) or guideline-recommended (target SBP <180 mm Hg) BP lowering treatment. Treatment effects were examined according to repeated measures analysis of an ordinal (‘shift') across all 7 levels of the modified Rankin Scale (mRS) assessed during follow-up at 7, 28, and 90 days, post-randomization. Clinical trial registration information: http://www.clinicaltrials.gov, NCT00226096 and NCT00716079. Results: Intensive BP lowering resulted in a significant favorable distribution of mRS scores for better functioning (odds ratio 1.13, 95% confidence interval 1.00-1.26; p = 0.042) over 7, 28 and 90 days, and the effect was consistency for early (7-28 days) and later (28-90 days) time periods (p homogeneity 0.353). Treatment effects were also consistent across several pre-specified patient characteristic subgroups, with trends favoring those randomized early, and with higher SBP and milder neurological severity at baseline. Conclusions: Intensive BP lowering provides beneficial effects on physical functioning that manifests consistently through the early and later phases of recovery from ICH.
copBasel, Switzerland
pubS. Karger AG
pmid25823544
doi10.1159/000381107
tpages7