Shoichiro Sato1, Hisatomi Arima1, Yoichiro Hirakawa1, Emma Heeley1, Candice Delcourt1, Ronny Beer1, Yuechun Li1, Jingfen Zhang1, Eric Jüettler1, Jiguang Wang1, Pablo M Lavados1, Thompson Robinson1, Richard I Lindley1, John Chalmers1, Craig S Anderson2. 1. From The George Institute for Global Health (S.S., H.A., Y.H., E.H., C.D., R.I.L., J.C., C.S.A.), the University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Neurology (R.B.), Innsbruck Medical University, Austria; Department of Neurology (Y.L., J.Z.), Baotou Central Hospital, China; Center for Stroke Research Berlin (E.J.), Charité-University Medicine Berlin, Germany; The Shanghai Institute of Hypertension (J.W.), Ruijin Hospital, Shanghai Jiaotong University, China; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; and Department of Cardiovascular Sciences (T.R.), Leicester Royal Infirmary, University of Leicester, UK. 2. From The George Institute for Global Health (S.S., H.A., Y.H., E.H., C.D., R.I.L., J.C., C.S.A.), the University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Neurology (R.B.), Innsbruck Medical University, Austria; Department of Neurology (Y.L., J.Z.), Baotou Central Hospital, China; Center for Stroke Research Berlin (E.J.), Charité-University Medicine Berlin, Germany; The Shanghai Institute of Hypertension (J.W.), Ruijin Hospital, Shanghai Jiaotong University, China; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; and Department of Cardiovascular Sciences (T.R.), Leicester Royal Infirmary, University of Leicester, UK. canderson@georgeinstitute.org.au.
Abstract
OBJECTIVE: The prognostic importance of the speed of early hematoma growth in acute intracerebral hemorrhage (ICH) has not been well established. We aimed to determine the association between the rate of increase in hematoma volume and major clinical outcomes in the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) studies. The effects of early intensive blood pressure (BP) lowering according to the speed of hematoma growth were also investigated. METHODS: Pooled analyses of the INTERACT1 (n = 404) and INTERACT2 (n = 2,839) studies-randomized controlled trials of patients with spontaneous ICH with elevated systolic BP, randomly assigned to intensive (target systolic BP <140 mm Hg) or guideline-based (<180 mm Hg) BP management. The speed of ultraearly hematoma growth (UHG) was defined as hematoma volume (mL)/onset-to-CT time (hours). Primary outcome was death or major disability (modified Rankin Scale score of 3-6) at 90 days. RESULTS: Among a total of 2,909 patients (90%) with information on UHG and outcome, median speed of UHG was 6.2 mL/h. There was a linear association between UHG and outcome: multivariable-adjusted odd ratios 1.90 (95% confidence interval 1.50-2.39) for 5-10 mL/h and 2.96 (2.36-3.71) for >10 mL/h vs the <5 mL/h group. There were no clear differences in the effects of intensive BP lowering according to 3 speeds of UHG on outcome (p = 0.75 for homogeneity). CONCLUSIONS: The speed of UHG in patients with ICH was continuously associated with increased risks of death or major disability, and from lower levels than previously reported (≥5 mL/h). The benefits of intensive BP lowering appear to be independent of the speed of bleeding.
RCT Entities:
OBJECTIVE: The prognostic importance of the speed of early hematoma growth in acute intracerebral hemorrhage (ICH) has not been well established. We aimed to determine the association between the rate of increase in hematoma volume and major clinical outcomes in the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) studies. The effects of early intensive blood pressure (BP) lowering according to the speed of hematoma growth were also investigated. METHODS: Pooled analyses of the INTERACT1 (n = 404) and INTERACT2 (n = 2,839) studies-randomized controlled trials of patients with spontaneous ICH with elevated systolic BP, randomly assigned to intensive (target systolic BP <140 mm Hg) or guideline-based (<180 mm Hg) BP management. The speed of ultraearly hematoma growth (UHG) was defined as hematoma volume (mL)/onset-to-CT time (hours). Primary outcome was death or major disability (modified Rankin Scale score of 3-6) at 90 days. RESULTS: Among a total of 2,909 patients (90%) with information on UHG and outcome, median speed of UHG was 6.2 mL/h. There was a linear association between UHG and outcome: multivariable-adjusted odd ratios 1.90 (95% confidence interval 1.50-2.39) for 5-10 mL/h and 2.96 (2.36-3.71) for >10 mL/h vs the <5 mL/h group. There were no clear differences in the effects of intensive BP lowering according to 3 speeds of UHG on outcome (p = 0.75 for homogeneity). CONCLUSIONS: The speed of UHG in patients with ICH was continuously associated with increased risks of death or major disability, and from lower levels than previously reported (≥5 mL/h). The benefits of intensive BP lowering appear to be independent of the speed of bleeding.
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