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Intensive blood-pressure lowering in patients with acute cerebral hemorrhage

  • Sufyan Alrahbi (a1), Rashid Alaraimi (a1), Abdalla Alzaabi (a1) and Sophie Gosselin (a2) (a3)

Abstract

Clinical question

Is intensive blood pressure (BP) treatment (systolic BP target 110-139 mm Hg) better than standard antihypertensive treatment (systolic BP target 140-179 mm Hg) in reducing mortality and disability in patients with acute intracerebral hemorrhage (ICH)?

Article chosen

Qureshi AI, Palesch YY, Barsan WG, et al. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med 2016;375(11):1033-43.

Objective

To determine the therapeutic benefit of intensive BP treatment compared to standard BP treatment in reducing death and disability after 3 months of follow-up among patients with ICH treated within 4.5 hours from onset of symptoms.

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Copyright

Corresponding author

Correspondence to: Dr. Sufyan Alrahbi, McGill University Health Centre, 1001 Boulevard Décarie, Room CS16237.1, Montreal, QC H4A 3J1; Email: Sufyan.alrahbi@mail.mcgill.ca

References

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1. Qureshi, AI. The importance of acute hypertensive response in ICH. Stroke 2013;44:S67-s69, 10.1161/STROKEAHA.111.000758.
2. Anderson, CS, Huang Y, Arima H, et al. Effects of early intensive blood pressure-lowering treatment on the growth of hematoma and perihematomal edema in acute intracerebral hemorrhage: the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT). Stroke 2010;41(2):307-312.
3. Anderson, CS, Heeley E, Huang Y, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med 2013;368(25):2355-2365.
4. Qureshi, A, Palesch, Y, ATACH II Investigators. Expansion of recruitment time window in Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) II Trial. J Vasc Interv Neurol 2012;5:6-9.
5. Qureshi, AI, Antihypertensive Treatment of Acute Cerebral Hemorrhage Investigators. Antihypertensive treatment of acute cerebral hemorrhage (ATACH). Neurocrit Care 2007;6(1):56-66.
6. Guyatt, GH, Briel M, Glasziou P, et al. Problems of stopping trials early. BMJ 2012;344:e3863.
7. Jitlal, M, Khan, I, Lee, SM, et al. Stopping clinical trials early for futility: retrospective analysis of several randomised clinical studies. Br J Cancer 2012;107(6):910-917.
8. Schoenfeld, DA, Meade, MO. Pro/con clinical debate: it is acceptable to stop large multicentre randomized controlled trials at interim analysis for futility. Crit Care 2005;9(1):34-36, 10.1186/cc3013.
9. Kuramatsu, JB, Gerner, ST, Schellinger, PD, et al. Anticoagulant reversal, blood pressure levels, and anticoagulant resumption in patients with anticoagulation-related intracerebral hemorrhage. JAMA 2015;313(8):824-836, 10.1001/jama.2015.0846.
10. Parry-Jones, AR, Abid KA, Di Napoli M, et al. Accuracy and clinical usefulness of intracerebral hemorrhage grading scores: a direct comparison in a UK population. Stroke 2013;44(7):1840-1845.

Keywords

Intensive blood-pressure lowering in patients with acute cerebral hemorrhage

  • Sufyan Alrahbi (a1), Rashid Alaraimi (a1), Abdalla Alzaabi (a1) and Sophie Gosselin (a2) (a3)

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