Andrea Morotti1, Ashkan Shoamanesh2, Jamary Oliveira-Filho3, Frieder Schlunk3, Javier M Romero4, Michael Jessel3, Alison Ayres3, Anastasia Vashkevich3, Kristin Schwab3, Christy Cassarly5, Renee' Hebert Martin5, Steven M Greenberg3, Adnan I Qureshi6, Jonathan Rosand3,7,8,9, Joshua N Goldstein3,7,10. 1. Department of Neurology and Neurorehabilitation, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy. andrea.morotti85@gmail.com. 2. Population Health Research Institute, McMaster University, Hamilton, ON, Canada. 3. J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA. 4. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA. 5. Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA. 6. Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, USA. 7. Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA. 8. Henry and Allison Center for Brain Health, Massachusetts General Hospital, Harvard Medical School, Boston, USA. 9. Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA. 10. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Abstract
BACKGROUND: It is not clear whether subsets of patients with intracerebral hemorrhage (ICH) benefit from intensive blood pressure (BP) lowering. We evaluated whether white matter hyperintensities (WMH) burden influences response to this therapy. METHODS: Retrospective secondary analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 trial. Patients were randomized to intensive (systolic BP target: 110-139 mmHg) versus standard (systolic BP target: 140-179 mmHg) BP treatment with intravenous nicardipine within 4.5 h from onset between May 2011 and September 2015. WMH were rated on magnetic resonance images (fluid-attenuated inversion recovery sequences), defining moderate-severe WMH as total Fazekas scale score ≥ 3 (range 0-6). The main outcome was death or major disability at 90 days (modified Rankin scale ≥ 3). The secondary outcome was ICH expansion, defined as hematoma growth > 33% from baseline to follow-up CT scan. Predictors of the outcomes of interest were explored with multivariable logistic regression. RESULTS: A total of 195/1000 patients had MRI images available for analysis, of whom 161 (82.6%) had moderate-severe WMH. When compared to patients with none-mild WMH, those with moderate-severe WMH did not have an increased risk of death or major disability (adjusted relative risk: 1.83, 95% CI 0.71-4.69) or ICH expansion (adjusted relative risk: 1.14, 95% CI 0.38-3.37). WMH burden did not modify the effect of intensive BP treatment on outcome (all p for interaction ≥ 0.2). CONCLUSION: The majority of acute ICH patients have moderate-severe WMH, but advanced small vessel disease burden marked by WMH does not influence ICH-related outcomes or response to intensive BP reduction.
BACKGROUND: It is not clear whether subsets of patients with intracerebral hemorrhage (ICH) benefit from intensive blood pressure (BP) lowering. We evaluated whether white matter hyperintensities (WMH) burden influences response to this therapy. METHODS: Retrospective secondary analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 trial. Patients were randomized to intensive (systolic BP target: 110-139 mmHg) versus standard (systolic BP target: 140-179 mmHg) BP treatment with intravenous nicardipine within 4.5 h from onset between May 2011 and September 2015. WMH were rated on magnetic resonance images (fluid-attenuated inversion recovery sequences), defining moderate-severe WMH as total Fazekas scale score ≥ 3 (range 0-6). The main outcome was death or major disability at 90 days (modified Rankin scale ≥ 3). The secondary outcome was ICH expansion, defined as hematoma growth > 33% from baseline to follow-up CT scan. Predictors of the outcomes of interest were explored with multivariable logistic regression. RESULTS: A total of 195/1000 patients had MRI images available for analysis, of whom 161 (82.6%) had moderate-severe WMH. When compared to patients with none-mild WMH, those with moderate-severe WMH did not have an increased risk of death or major disability (adjusted relative risk: 1.83, 95% CI 0.71-4.69) or ICH expansion (adjusted relative risk: 1.14, 95% CI 0.38-3.37). WMH burden did not modify the effect of intensive BP treatment on outcome (all p for interaction ≥ 0.2). CONCLUSION: The majority of acute ICH patients have moderate-severe WMH, but advanced small vessel disease burden marked by WMH does not influence ICH-related outcomes or response to intensive BP reduction.
Entities:
Keywords:
Blood pressure; Intracerebral hemorrhage; Leukoaraiosis; Small vessel disease; Stroke; White matter hyperintensities
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