Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage

Craig S. Anderson, Emma Heeley, Yining Huang, Jiguang Wang, Christian Stapf, Candice Delcourt, Richard Lindley, Thompson Robinson, Pablo Lavados, Bruce Neal, Jun Hata, Hisatomi Arima, Mark Parsons, Yuechun Li, Jinchao Wang, Stephane Heritier, Qiang Li, Mark Woodward, R. John Simes, Stephen M. Davis & 1 others John Chalmers

Research output: Contribution to journalArticle

689 Citations (Scopus)

Abstract

BACKGROUND: Whether rapid lowering of elevated blood pressure would improve the outcome in patients with intracerebral hemorrhage is not known. METHODS: We randomly assigned 2839 patients who had had a spontaneous intracerebral hemorrhage within the previous 6 hours and who had elevated systolic blood pressure to receive intensive treatment to lower their blood pressure (with a target systolic level of <140 mm Hg within 1 hour) or guideline-recommended treatment (with a target systolic level of <180 mm Hg) with the use of agents of the physician's choosing. The primary outcome was death or major disability, which was defined as a score of 3 to 6 on the modified Rankin scale (in which a score of 0 indicates no symptoms, a score of 5 indicates severe disability, and a score of 6 indicates death) at 90 days. A prespecified ordinal analysis of the modified Rankin score was also performed. The rate of serious adverse events was compared between the two groups. RESULTS: Among the 2794 participants for whom the primary outcome could be determined, 719 of 1382 participants (52.0%) receiving intensive treatment, as compared with 785 of 1412 (55.6%) receiving guideline-recommended treatment, had a primary outcome event (odds ratio with intensive treatment, 0.87; 95% confidence interval [CI], 0.75 to 1.01; P = 0.06). The ordinal analysis showed significantly lower modified Rankin scores with intensive treatment (odds ratio for greater disability, 0.87; 95% CI, 0.77 to 1.00; P = 0.04). Mortality was 11.9% in the group receiving intensive treatment and 12.0% in the group receiving guideline-recommended treatment. Nonfatal serious adverse events occurred in 23.3% and 23.6% of the patients in the two groups, respectively. CONCLUSIONS: In patients with intracerebral hemorrhage, intensive lowering of blood pressure did not result in a significant reduction in the rate of the primary outcome of death or severe disability. An ordinal analysis of modified Rankin scores indicated improved functional outcomes with intensive lowering of blood pressure. (Funded by the National Health and Medical Research Council of Australia; INTERACT2 ClinicalTrials.gov number, NCT00716079.)

Original languageEnglish
Pages (from-to)2355-2365
Number of pages11
JournalNew England Journal of Medicine
Volume368
Issue number25
DOIs
Publication statusPublished - Jan 1 2013

Fingerprint

Cerebral Hemorrhage
Blood Pressure
Guidelines
Therapeutics
Odds Ratio
Confidence Intervals
Biomedical Research
Physicians
Mortality
Health

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Anderson, C. S., Heeley, E., Huang, Y., Wang, J., Stapf, C., Delcourt, C., ... Chalmers, J. (2013). Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. New England Journal of Medicine, 368(25), 2355-2365. https://doi.org/10.1056/NEJMoa1214609

Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. / Anderson, Craig S.; Heeley, Emma; Huang, Yining; Wang, Jiguang; Stapf, Christian; Delcourt, Candice; Lindley, Richard; Robinson, Thompson; Lavados, Pablo; Neal, Bruce; Hata, Jun; Arima, Hisatomi; Parsons, Mark; Li, Yuechun; Wang, Jinchao; Heritier, Stephane; Li, Qiang; Woodward, Mark; Simes, R. John; Davis, Stephen M.; Chalmers, John.

In: New England Journal of Medicine, Vol. 368, No. 25, 01.01.2013, p. 2355-2365.

Research output: Contribution to journalArticle

Anderson, CS, Heeley, E, Huang, Y, Wang, J, Stapf, C, Delcourt, C, Lindley, R, Robinson, T, Lavados, P, Neal, B, Hata, J, Arima, H, Parsons, M, Li, Y, Wang, J, Heritier, S, Li, Q, Woodward, M, Simes, RJ, Davis, SM & Chalmers, J 2013, 'Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage', New England Journal of Medicine, vol. 368, no. 25, pp. 2355-2365. https://doi.org/10.1056/NEJMoa1214609
Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. New England Journal of Medicine. 2013 Jan 1;368(25):2355-2365. https://doi.org/10.1056/NEJMoa1214609
Anderson, Craig S. ; Heeley, Emma ; Huang, Yining ; Wang, Jiguang ; Stapf, Christian ; Delcourt, Candice ; Lindley, Richard ; Robinson, Thompson ; Lavados, Pablo ; Neal, Bruce ; Hata, Jun ; Arima, Hisatomi ; Parsons, Mark ; Li, Yuechun ; Wang, Jinchao ; Heritier, Stephane ; Li, Qiang ; Woodward, Mark ; Simes, R. John ; Davis, Stephen M. ; Chalmers, John. / Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. In: New England Journal of Medicine. 2013 ; Vol. 368, No. 25. pp. 2355-2365.
@article{130873b276304f9bb9c12a9f89220905,
title = "Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage",
abstract = "BACKGROUND: Whether rapid lowering of elevated blood pressure would improve the outcome in patients with intracerebral hemorrhage is not known. METHODS: We randomly assigned 2839 patients who had had a spontaneous intracerebral hemorrhage within the previous 6 hours and who had elevated systolic blood pressure to receive intensive treatment to lower their blood pressure (with a target systolic level of <140 mm Hg within 1 hour) or guideline-recommended treatment (with a target systolic level of <180 mm Hg) with the use of agents of the physician's choosing. The primary outcome was death or major disability, which was defined as a score of 3 to 6 on the modified Rankin scale (in which a score of 0 indicates no symptoms, a score of 5 indicates severe disability, and a score of 6 indicates death) at 90 days. A prespecified ordinal analysis of the modified Rankin score was also performed. The rate of serious adverse events was compared between the two groups. RESULTS: Among the 2794 participants for whom the primary outcome could be determined, 719 of 1382 participants (52.0{\%}) receiving intensive treatment, as compared with 785 of 1412 (55.6{\%}) receiving guideline-recommended treatment, had a primary outcome event (odds ratio with intensive treatment, 0.87; 95{\%} confidence interval [CI], 0.75 to 1.01; P = 0.06). The ordinal analysis showed significantly lower modified Rankin scores with intensive treatment (odds ratio for greater disability, 0.87; 95{\%} CI, 0.77 to 1.00; P = 0.04). Mortality was 11.9{\%} in the group receiving intensive treatment and 12.0{\%} in the group receiving guideline-recommended treatment. Nonfatal serious adverse events occurred in 23.3{\%} and 23.6{\%} of the patients in the two groups, respectively. CONCLUSIONS: In patients with intracerebral hemorrhage, intensive lowering of blood pressure did not result in a significant reduction in the rate of the primary outcome of death or severe disability. An ordinal analysis of modified Rankin scores indicated improved functional outcomes with intensive lowering of blood pressure. (Funded by the National Health and Medical Research Council of Australia; INTERACT2 ClinicalTrials.gov number, NCT00716079.)",
author = "Anderson, {Craig S.} and Emma Heeley and Yining Huang and Jiguang Wang and Christian Stapf and Candice Delcourt and Richard Lindley and Thompson Robinson and Pablo Lavados and Bruce Neal and Jun Hata and Hisatomi Arima and Mark Parsons and Yuechun Li and Jinchao Wang and Stephane Heritier and Qiang Li and Mark Woodward and Simes, {R. John} and Davis, {Stephen M.} and John Chalmers",
year = "2013",
month = "1",
day = "1",
doi = "10.1056/NEJMoa1214609",
language = "English",
volume = "368",
pages = "2355--2365",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "25",

}

TY - JOUR

T1 - Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage

AU - Anderson, Craig S.

AU - Heeley, Emma

AU - Huang, Yining

AU - Wang, Jiguang

AU - Stapf, Christian

AU - Delcourt, Candice

AU - Lindley, Richard

AU - Robinson, Thompson

AU - Lavados, Pablo

AU - Neal, Bruce

AU - Hata, Jun

AU - Arima, Hisatomi

AU - Parsons, Mark

AU - Li, Yuechun

AU - Wang, Jinchao

AU - Heritier, Stephane

AU - Li, Qiang

AU - Woodward, Mark

AU - Simes, R. John

AU - Davis, Stephen M.

AU - Chalmers, John

PY - 2013/1/1

Y1 - 2013/1/1

N2 - BACKGROUND: Whether rapid lowering of elevated blood pressure would improve the outcome in patients with intracerebral hemorrhage is not known. METHODS: We randomly assigned 2839 patients who had had a spontaneous intracerebral hemorrhage within the previous 6 hours and who had elevated systolic blood pressure to receive intensive treatment to lower their blood pressure (with a target systolic level of <140 mm Hg within 1 hour) or guideline-recommended treatment (with a target systolic level of <180 mm Hg) with the use of agents of the physician's choosing. The primary outcome was death or major disability, which was defined as a score of 3 to 6 on the modified Rankin scale (in which a score of 0 indicates no symptoms, a score of 5 indicates severe disability, and a score of 6 indicates death) at 90 days. A prespecified ordinal analysis of the modified Rankin score was also performed. The rate of serious adverse events was compared between the two groups. RESULTS: Among the 2794 participants for whom the primary outcome could be determined, 719 of 1382 participants (52.0%) receiving intensive treatment, as compared with 785 of 1412 (55.6%) receiving guideline-recommended treatment, had a primary outcome event (odds ratio with intensive treatment, 0.87; 95% confidence interval [CI], 0.75 to 1.01; P = 0.06). The ordinal analysis showed significantly lower modified Rankin scores with intensive treatment (odds ratio for greater disability, 0.87; 95% CI, 0.77 to 1.00; P = 0.04). Mortality was 11.9% in the group receiving intensive treatment and 12.0% in the group receiving guideline-recommended treatment. Nonfatal serious adverse events occurred in 23.3% and 23.6% of the patients in the two groups, respectively. CONCLUSIONS: In patients with intracerebral hemorrhage, intensive lowering of blood pressure did not result in a significant reduction in the rate of the primary outcome of death or severe disability. An ordinal analysis of modified Rankin scores indicated improved functional outcomes with intensive lowering of blood pressure. (Funded by the National Health and Medical Research Council of Australia; INTERACT2 ClinicalTrials.gov number, NCT00716079.)

AB - BACKGROUND: Whether rapid lowering of elevated blood pressure would improve the outcome in patients with intracerebral hemorrhage is not known. METHODS: We randomly assigned 2839 patients who had had a spontaneous intracerebral hemorrhage within the previous 6 hours and who had elevated systolic blood pressure to receive intensive treatment to lower their blood pressure (with a target systolic level of <140 mm Hg within 1 hour) or guideline-recommended treatment (with a target systolic level of <180 mm Hg) with the use of agents of the physician's choosing. The primary outcome was death or major disability, which was defined as a score of 3 to 6 on the modified Rankin scale (in which a score of 0 indicates no symptoms, a score of 5 indicates severe disability, and a score of 6 indicates death) at 90 days. A prespecified ordinal analysis of the modified Rankin score was also performed. The rate of serious adverse events was compared between the two groups. RESULTS: Among the 2794 participants for whom the primary outcome could be determined, 719 of 1382 participants (52.0%) receiving intensive treatment, as compared with 785 of 1412 (55.6%) receiving guideline-recommended treatment, had a primary outcome event (odds ratio with intensive treatment, 0.87; 95% confidence interval [CI], 0.75 to 1.01; P = 0.06). The ordinal analysis showed significantly lower modified Rankin scores with intensive treatment (odds ratio for greater disability, 0.87; 95% CI, 0.77 to 1.00; P = 0.04). Mortality was 11.9% in the group receiving intensive treatment and 12.0% in the group receiving guideline-recommended treatment. Nonfatal serious adverse events occurred in 23.3% and 23.6% of the patients in the two groups, respectively. CONCLUSIONS: In patients with intracerebral hemorrhage, intensive lowering of blood pressure did not result in a significant reduction in the rate of the primary outcome of death or severe disability. An ordinal analysis of modified Rankin scores indicated improved functional outcomes with intensive lowering of blood pressure. (Funded by the National Health and Medical Research Council of Australia; INTERACT2 ClinicalTrials.gov number, NCT00716079.)

UR - http://www.scopus.com/inward/record.url?scp=84879082528&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84879082528&partnerID=8YFLogxK

U2 - 10.1056/NEJMoa1214609

DO - 10.1056/NEJMoa1214609

M3 - Article

VL - 368

SP - 2355

EP - 2365

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 25

ER -