Blood Pressure-Attained Analysis of ATACH 2 Trial

Area of Science:

• Neurology
• Cardiology
• Critical Care Medicine

Background:

• Intracerebral hemorrhage (ICH) is a critical condition often associated with high blood pressure.
• Effective management of systolic blood pressure (SBP) in ICH patients is crucial for improving outcomes.
• Previous studies have investigated various SBP targets, but the optimal strategy remains debated.

Purpose of the Study:

• To compare the rates of death or disability at 3 months in ICH patients based on post-treatment systolic blood pressure (SBP) attained.
• To evaluate the impact of achieving and maintaining a lower SBP target on clinical outcomes and adverse events.

Main Methods:

• A randomized trial involving 1000 ICH patients with SBP ≥180 mm Hg, randomized within 4.5 hours of symptom onset.
• Patients were grouped based on achieving SBP <140 mm Hg within 2 hours: reduced and maintained, or reduced but not maintained.
• Outcomes including death, disability (modified Rankin Scale 4-6), neurological deterioration, and cardiac events were assessed.

Main Results:

• Achieving and maintaining SBP <140 mm Hg within 2 hours did not significantly alter the rate of death or disability at 3 months compared to no reduction.
• Significantly higher rates of neurological deterioration within 24 hours were observed in both the reduced and maintained (10.4%) and reduced but not maintained (11.5%) groups.
• Cardiac-related adverse events within 7 days were more frequent in the group with reduction and maintenance of SBP <140 mm Hg (11.2%) compared to the reference group (6.4%).

Conclusions:

• Intensive SBP reduction to <140 mm Hg in ICH patients, whether maintained or not, did not improve 3-month death or disability rates.
• Aggressive SBP management was associated with increased risks of neurological deterioration and cardiac-related adverse events.
• These findings suggest caution when applying intensive SBP reduction strategies in the acute phase of intracerebral hemorrhage.