Format

Send to

Choose Destination
See comment in PubMed Commons below
N Engl J Med. 2013 Jun 20;368(25):2355-65. doi: 10.1056/NEJMoa1214609. Epub 2013 May 29.

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

Collaborators (750)

Anderson CS, Chalmers J, Arima H, Davis S, Heeley E, Huang Y, Lavados P, Neal B, Parsons MW, Lindley R, Morgenstern L, Robinson T, Stapf C, Tzourio C, Wang JG, Huang Y, Chen S, Chen XY, Cui L, Liu Z, Lu C, Wang J, Wu S, Xu E, Yang Q, Zhang C, Zhang J, Beer R, Schmutzhard E, Redondo P, Kaste M, Soinne L, Tatlisumak T, Stapf C, Wartenberg K, Ricci S, Klijn K, Azevedo E, Chamorro A, Arnold M, Fischer U, Kaul S, Pandian J, Boyini H, Singh S, Rabinstein AA, Estol C, Silva G, Lavados P, Olavarria VV, Robinson TG, Simes RJ, Bousser MG, Hankey G, Jamrozik K, Johnston SC, Li S, Heeley E, Anderson CS, Bailey K, Chalmers J, Cheung T, Delcourt C, Chintapatla S, Ducasse E, Erho T, Hata J, Holder B, Knight E, Lindley R, Leroux M, Sassé T, Odgers E, Walsh R, Wolfowicz Z, Anderson CS, Chen G, Delcourt C, Fuentes S, Lindley R, Peng B, Schneble HM, Wang MX, Arima H, Billot L, Heritier S, Li Q, Woodward M, Delcourt C, Abimbola S, Anderson S, Chan E, Cheng G, Chmielnik P, Hata J, Leighton S, Liu JY, Rasmussen B, Saxena A, Tripathy S, Armenis M, Baig MA, Naidu B, Starzec G, Steley S, Anderson CS, Heeley E, Leroux M, Delcourt C, Sassé T, Knight E, Bailey K, Cheung T, Odgers E, Ducasse E, Holder B, Wolfowicz Z, Walsh R, Chintapatla S, Erho T, Estol C, Moles A, Ruiz A, Zimmermann M, Marinho J, Alves S, Angelim R, Araujo J, Kawakami L, Lavados P, Olavarria VV, Bustos C, Gonzalez F, Venturelli P, Huang Y, Chen X, Huang Y, Jia R, Li N, Qu S, Shu Y, Song A, Sun J, Xiao J, Zhao Y, Wang JG, Huang Q, Stapf C, Vicaut E, Chamam A, Viaud MC, Dert C, Fiedler U, Jovis V, Kabla S, Marchand S, Pena A, Rochaud V, Boyini KM, Hasan N, Berge E, Sandset EC, Forårsveen AS, Robinson T, Richardson D, Kumar T, Lewin S, Poulter N, Field J, Anjum A, Wilson A, Perelmuter H, Agarie AM, Barboza AG, Recchia LA, Miranda IF, Rauek SG, Duplessis RJ, Dewey H, Walker L, Petrolo S, Bladin C, Sturm J, Crimmins D, Griffiths D, Schutz A, Zenteno V, Parsons MW, Miteff F, Spratt N, Kerr E, Levi CR, Phan TG, Ma H, Sanders L, Moran C, Wong K, Read S, Henderson R, Wong A, Hull R, Skinner G, Davis S, Hand P, Yan B, Tu H, Campbell B, Anderson CS, Delcourt C, Blacker DJ, Wijeratne T, Pathirage M, Jasinararchchi M, Matkovic Z, Celestino S, Gruber F, Vosko MR, Diabl E, Rathmaier S, Beer R, Schmutzhard E, Pfausler B, Helbok R, Fazekas F, Fischer R, Poltrum B, Zechner B, Trummer U, Rutgers MP, Peeters A, Dusart A, Duray MC, Parmentier C, Ferrao-Santos S, Brouns R, De Raedt S, De Smedt A, Van Hooff RJ, De Keyser J, Martins SC, de Almeida AG, Broudani R, Titton NF, de Freitas GR, Cardoso FM, Giesel LM, Lima Junior NA, de Almeida AC, Gomes RB, dos Santos TS, Soares EM, Neto OL, Silva GS, Gomes DL, de Carvalho FA, Miranda M, Marques A, Zétola VF, de Matia G, Lange MC, Montes J, Reccius A, Venturelli PM, Olavarria VV, Soto A, Rivas R, Klapp C, Illanes S, Aguilera C, Castro A, Figueroa C, Benavides J, Salamanca P, Concha MC, Pajarito J, Araya P, Guerra F, Li Y, Liu G, Wang B, Zhang J, Chong Y, He M, Wang L, Liu J, Zhang X, Lai C, Jiang H, Yang Q, Cui S, Tao Q, Zhang Y, Yao S, Xu M, Zhang Y, Liu Z, Xiao H, Hu J, Tang J, Sun J, Ji H, Jiang M, Yu F, Zhang Y, Yang X, Guo X, Wang Y, Wu L, Liu Z, Gao Y, Sun D, Huang X, Wang Y, Liu L, Li Y, Li P, Jiang Y, Li H, Lu H, Zhou J, Yuan C, Qi X, Qiu F, Qian H, Wang W, Liu J, Huang Y, Sun W, Li F, Liu R, Peng Q, Ren Z, Fan C, Zhang Y, Wang H, Wang T, Shi F, Duan C, Chen S, Wang J, Chen Z, Tan X, Zhao Z, Gao Y, Chen J, Han T, Wu S, Zhang L, Wang L, Hu Q, Hou Q, Zhao X, Wang L, Zeng G, Ma L, Wang F, Chen S, Zeng L, Guo Z, Fu Y, Song Y, Tai L, Liu X, Su X, Yang Y, Dong R, Xu Y, Tian S, Cheng S, Su L, Xie X, Xu T, Geng D, Yan X, Fan H, Zhao N, Wang S, Yang J, Zhang J, Yan M, Li L, Li Z, Xu X, Wang F, Wu L, Guo X, Lian Y, Sun H, Liu D, Wang N, Tang Q, Han Z, Feng L, Cui Y, Tian J, Chang H, Sun X, Wang J, Liu C, Wen Z, Xu E, Lin Q, Zhang X, Sun L, Hu B, Zou M, Bao Q, Lin X, Zhao L, Tian X, Wang H, Wang X, Li X, Hao L, Duan Y, Wang R, Wei Z, Liu J, Ren S, Ren H, Wang Y, Dong Y, Cheng Y, Zou M, Liu W, Han J, Zhang C, Zhang Z, Zhu J, Wang Y, Li Q, Qian J, Sun Y, Liu K, Long F, Peng X, Zhang Q, Yuan Z, Wang C, Huang M, Zhang J, Wang F, He P, You Y, Wang X, Yang Q, Wang H, Xia J, Zhou L, Hou Y, Wang Y, Liu L, Qi Y, Mei L, Lu R, Chen G, Liu L, Ping L, Liu W, Zhou S, Wang J, Wang L, Li H, Zhang S, Wang L, Zou R, Guo J, Li M, Wei W, Soinne L, Curtze S, Saarela M, Strbian D, Scheperjans F, De Broucker T, Henry C, Cumurciuc R, Ibos-Augé N, Zéghoudi AC, Pico F, Dereeper O, Simian MC, Boisselier C, Mahfoud A, Timsit S, Merrien FM, Guillon B, Sevin M, Herisson F, Magne C, Ameri A, Cret C, Stefanizzi S, Klapzcynski F, Denier C, Sarov-Riviere M, Stapf C, Reiner P, Mawet J, Hervé D, Buffon F, Touzé E, Domigo V, Lamy C, Calvet D, Pasquini M, Alamowitch S, Favrole P, Muresan IP, Crozier S, Rosso C, Pires C, Leger A, Deltour S, Cordonnier C, Henon H, Rossi C, Zuber M, Bruandet M, Tamazyan R, Join-Lambert C, Juettler E, Krause T, Maul S, Endres M, Jungehulsing GJ, Hennerici M, Griebe M, Sauer T, Knoll K, Huber R, Knauer K, Knauer C, Raubold S, Schneider H, Hentschel H, Lautenschläger C, Schimmel E, Dzialowski I, Foerch C, Lorenz M, Singer O, dos Santos IM, Hartmann A, Hamann A, Schacht A, Schrader B, Teíchmann A, Wartenberg KE, Mueller TJ, Jander S, Gliem M, Boettcher C, Rosenkranz M, Beck C, Otto D, Thomalla G, Cheng B, Wong KS, Leung TW, Soo YO, Prabhakar S, Kesavarapu SR, Gajjela PK, Chenna RR, Ummer K, Basheer M, Andipet A, Jagarlapudi MK, Mohammed AU, Pawar VG, Eranki SS, Pandian J, Singh Y, Akhtar N, Borah NC, Ghose M, Choudhury N, Ichaporia NR, Shendge J, Khese S, Pamidimukkala V, Inbamuthaiah P, Nuthakki SR, Tagallamudi NM, Gutti AK, Khurana D, Kesavarapu P, Jogi V, Garg A, Samanta D, Sarma GR, Nadig R, Mathew T, Anandan MA, Caterbi E, Zini A, Cavazzuti M, Casoni F, Pentore R, Falzone F, Ricci S, Mazzoli T, Greco LM, Menichetti C, Coppola F, Cenciarelli S, Gallinella E, Mattioni A, Condurso R, Sicilia I, Zampolini M, Corea F, Barbi M, Proietti C, Toni D, Pieroni A, Anzini A, Falcou A, Demichele M, Klijn CJ, Tveiten A, Thortveit ET, Pettersen S, Holand N, Hitland B, Johnsen SH, Eltoft A, Wasay M, Kamal A, Iqrar A, Ali L, Begum D, Gama G, Azevedo E, Fonseca L, Moreira G, Veloso LM, Pinheiro D, Paredes L, Rozeira C, Gregorio T, Martin TS, Ayo O, Garcia-Garcia J, Vilar IF, Fernández IG, Chamorro A, Amaro S, Urra X, Obach V, Cervera A, Silva Y, Serena J, Castellanos M, Terceno M, Van Eendenburg C, Fischer U, Arnold M, Weck A, Findling O, Lüdi R, Warburton EA, Day D, Butler N, Bumanlag E, Caine S, Steele A, Osborn M, Dodd E, Murphy P, Esisi B, Brown E, Hayman R, Baliga VK, Minphone M, Kennedy J, Reckless I, Pope G, Teal R, Michael K, Manawadu D, Kalra L, Lewis R, Mistry B, Cattermole E, Hassan A, Mandizvidza L, Bamford J, Brooks H, Bedford C, Whiting R, Baines P, Hussain M, Harvey M, Fotherby K, McBride S, Bourke P, Morgan D, Jennings-Preece K, Price C, Huntley S, Riddell VE, Storey G, Lakey RL, Subramanian G, Jenkinson D, Kwan J, David O, Tiwari D, James M, Keenan S, Eastwood H, Shaw L, Kaye P, Button D, Madigan B, Williamson D, Dixit A, Davis J, Hossain MO, Ford GA, Parry-Jones A, O'Loughlin V, Jarapa R, Naing Z, Lovelock C, O'Reilly J, Khan U, Bhalla A, Rudd A, Birns J, Werring DJ, Law R, Perry R, Jones I, Erande R, Roffe C, Natarajan I, Ahmad N, Finney K, Lucas J, Mistri A, Eveson D, Marsh R, Haunton V, Robinson T, Rabinstein AA, Fugate JE, Lepore SW.

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.).

PMID:
23713578
DOI:
10.1056/NEJMoa1214609
[Indexed for MEDLINE]
Free full text
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Atypon
    Loading ...
    Support Center