Temporal Trajectory of Systolic Blood Pressure and Outcomes in Acute Intracerebral Hemorrhage: ATACH-2 Trial Cohort

Kanta Tanaka, Masatoshi Koga, Mayumi Fukuda-Doi, Adnan I Qureshi, Haruko Yamamoto, Kaori Miwa, Masafumi Ihara, Kazunori Toyoda, ATACH-2 Trial Investigators, Kanta Tanaka, Masatoshi Koga, Mayumi Fukuda-Doi, Adnan I Qureshi, Haruko Yamamoto, Kaori Miwa, Masafumi Ihara, Kazunori Toyoda, ATACH-2 Trial Investigators

Abstract

Background: To highlight the heterogeneity of acute temporal blood pressure (BP) changes in the ATACH-2 trial (Antihypertensive Treatment of Acute Cerebral Hemorrhage-2) and associations with the outcomes of intracerebral hemorrhage.

Methods: One thousand patients with acute intracerebral hemorrhage, who had been randomized to intensive (110-139 mm Hg) or standard (140-179 mm Hg) systolic BP (SBP) lowering with intravenous nicardipine in ATACH-2 from 2011 to 2015, were analyzed about temporal changes in hourly maximum SBP up to 24 hours after randomization using group-based trajectory modeling. Outcomes included death or disability (modified Rankin Scale score 4-6) at 3 months, neurological deterioration within 24 hours (≥2-point decrease in Glasgow Coma Scale score or ≥4-point increase in National Institutes of Health Stroke Scale score), and acute kidney injury (≥0.3 mg/dL within 48 hours or ≥1.5-fold increase in serum creatinine) within 7 days after onset.

Results: Group-based trajectory modeling revealed 4 SBP trajectory groups: moderate SBP (from ≈190 mm Hg at hospital arrival to 150-160 mm Hg after randomization; n=298), moderate-to-low SBP (from ≈190 mm Hg to <140 mm Hg; n=395), high-to-low SBP (from >210 mm Hg to <140 mm Hg; n=134), and high SBP (from >210 mm Hg to 160-170 mm Hg; n=173). Patients with intensive treatment accounted for 11.1%, 88.6%, 85.1%, and 1.7% of each group, respectively. Compared with the moderate-to-low SBP group, the high-to-low SBP group showed increased risks of death or disability at 3 months (adjusted odds ratio, 2.29 [95% CI, 1.24-4.26]) and acute kidney injury (adjusted odds ratio, 3.50 [95% CI, 1.83-6.69]), while no increase in neurological deterioration was seen in this group (adjusted odds ratio, 0.48 [95% CI, 0.20-1.13]). The moderate SBP and high SBP groups showed no significant risk differences for such outcomes.

Conclusions: Data-driven observation using a group-based trajectory modeling approach may be useful to clarify the relationship between antihypertensive treatment, temporal SBP changes, and outcomes in acute intracerebral hemorrhage.

Registration: URL: https://www.

Clinicaltrials: gov; Unique identifier: NCT01176565.

Keywords: acute kidney injury; antihypertensive agents; blood pressure; cerebral hemorrhage; nicardipine.

Figures

Figure.
Figure.
Trajectory groups of 24-h systolic blood pressure and model fit statistics. SBP indicates systolic blood pressure.

References

    1. Qureshi AI, Ezzeddine MA, Nasar A, Suri MF, Kirmani JF, Hussein HM, Divani AA, Reddi AS. Prevalence of elevated blood pressure in 563,704 adult patients with stroke presenting to the ED in the United States. Am J Emerg Med. 2007;25:32–38. doi: 10.1016/j.ajem.2006.07.008
    1. Kazui S, Minematsu K, Yamamoto H, Sawada T, Yamaguchi T. Predisposing factors to enlargement of spontaneous intracerebral hematoma. Stroke. 1997;28:2370–2375. doi: 10.1161/01.str.28.12.2370
    1. Sakamoto Y, Koga M, Yamagami H, Okuda S, Okada Y, Kimura K, Shiokawa Y, Nakagawara J, Furui E, Hasegawa Y, et al. ; SAMURAI Study Investigators. Systolic blood pressure after intravenous antihypertensive treatment and clinical outcomes in hyperacute intracerebral hemorrhage: the stroke acute management with urgent risk-factor assessment and improvement-intracerebral hemorrhage study. Stroke. 2013;44:1846–1851. doi: 10.1161/STROKEAHA.113.001212
    1. Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C, Lindley R, Robinson T, Lavados P, Neal B, et al. ; INTERACT2 Investigators. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013;368:2355–2365. doi: 10.1056/NEJMoa1214609
    1. Qureshi AI, Palesch YY, Barsan WG, Hanley DF, Hsu CY, Martin RL, Moy CS, Silbergleit R, Steiner T, Suarez JI, et al. ; ATACH-2 Trial Investigators and the Neurological Emergency Treatment Trials Network. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med. 2016;375:1033–1043. doi: 10.1056/NEJMoa1603460
    1. Qureshi AI. Acute hypertensive response in patients with stroke: pathophysiology and management. Circulation. 2008;118:176–187. doi: 10.1161/CIRCULATIONAHA.107.723874
    1. Kim BJ, Cho YJ, Hong KS, Lee J, Kim JT, Choi KH, Park TH, Park SS, Park JM, Kang K, et al. . Trajectory groups of 24-hour systolic blood pressure after acute ischemic stroke and recurrent vascular events. Stroke. 2018;49:1836–1842. doi: 10.1161/STROKEAHA.118.021117
    1. Nagin DS. Group-Based Modeling of Development. Harvard University Press; 2005.
    1. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kideny Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Inter Suppl. 2012;2:1–138. doi: 10.1038/kisup.2012.2
    1. Toyoda K, Koga M, Yamamoto H, Foster L, Palesch YY, Wang Y, Sakai N, Hara T, Hsu CY, Itabashi R, et al. ; ATACH-2 Trial Investigators. Clinical outcomes depending on acute blood pressure after cerebral hemorrhage. Ann Neurol. 2019;85:105–113. doi: 10.1002/ana.25379
    1. Burgess LG, Goyal N, Jones GM, Khorchid Y, Kerro A, Chapple K, Tsivgoulis G, Alexandrov AV, Chang JJ. Evaluation of acute kidney injury and mortality after intensive blood pressure control in patients with intracerebral hemorrhage. J Am Heart Assoc. 2018;7:e008439. doi: 10.1161/JAHA.117.008439
    1. Qureshi AI, Huang W, Lobanova I, Barsan WG, Hanley DF, Hsu CY, Lin CL, Silbergleit R, Steiner T, Suarez JI, et al. ; for ATACH-II trial investigators. Outcomes of intensive systolic blood pressure reduction in patients with intracerebral hemorrhage and excessively high initial systolic blood pressure: post hoc analysis of a randomized clinical trial. JAMA Neurol. 2020;77:1355–1365. doi: 10.1001/jamaneurol.2020.3075
    1. Singh BN, Josephson MA. Clinical pharmacology, pharmacokinetics, and hemodynamic effects of nicardipine. Am Heart J. 1990;119(2 Pt 2):427–434. doi: 10.1016/s0002-8703(05)80063-8
    1. Qureshi AI, Huang W, Lobanova I, Hanley DF, Hsu CY, Malhotra K, Steiner T, Suarez JI, Toyoda K, Yamamoto H; Antihypertensive Treatment of Cerebral Hemorrhage 2 Trial Investigators. systolic blood pressure reduction and acute kidney injury in intracerebral hemorrhage. Stroke. 2020;51:3030–3038. doi: 10.1161/STROKEAHA.120.030272
    1. Almeida JB, Saragoça MA, Tavares A, Cezareti ML, Draibe SA, Ramos OL. Severe hypertension induces disturbances of renal autoregulation. Hypertension. 1992;19(2 Suppl):II279–II283. doi: 10.1161/01.hyp.19.2_suppl.ii279
    1. Carlström M, Wilcox CS, Arendshorst WJ. Renal autoregulation in health and disease. Physiol Rev. 2015;95:405–511. doi: 10.1152/physrev.00042.2012
    1. Martini SR, Flaherty ML, Brown WM, Haverbusch M, Comeau ME, Sauerbeck LR, Kissela BM, Deka R, Kleindorfer DO, Moomaw CJ, et al. . Risk factors for intracerebral hemorrhage differ according to hemorrhage location. Neurology. 2012;79:2275–2282. doi: 10.1212/WNL.0b013e318276896f

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다