Different Responses to Blood Pressure Reduction in Lobar and Deep Intracerebral Hemorrhage.

IF 3.6 3区医学 Q2 CLINICAL NEUROLOGY

Neurocritical Care Pub Date : 2025-10-01 Epub Date: 2025-04-28 DOI:10.1007/s12028-025-02269-2

Santiago Clocchiatti-Tuozzo, Cyprien A Rivier, Adnan I Qureshi, Daniela Renedo, Shufan Huo, Charles Matouk, Nils Petersen, Adam de Havenon, Kevin N Sheth, Alejandro A Rabinstein, Guido J Falcone, Maximiliano A Hawkes

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引用次数: 0

Abstract

Background: Intensive blood pressure (BP) reduction may benefit patients with acute intracerebral hemorrhage (ICH), but it is unknown if those benefits apply equally to patients with lobar and deep ICH. Our objective was to assess the impact of intensive BP reduction on hematoma expansion (HE), 90-day functional outcomes, and renal adverse events (RAEs) in patients with deep ICH compared with those with lobar ICH.

Methods: This was an exploratory, post hoc analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2) randomized clinical trial, which investigated the efficacy of intensive BP reduction (110-139 mm Hg systolic BP) versus standard (140-179 mm Hg systolic BP) reduction 4.5 h after acute spontaneous ICH. Our end points of interest were HE (> 6 mL increase in hematoma volume between baseline and 24 h), 90-day functional outcome (modified Rankin Scale score 0-3 vs. 4-6), and RAEs.

Results: Of 1000 ATACH-2 participants, only 875 participants (87.5%) with complete neuroimaging data were included (778 [89%] deep and 97 [11%] lobar, mean age of 62 years, 62% male). Multivariable logistic regressions results showed that intensive BP reduction decreased the risk of HE (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.38-0.93; p = 0.024) and increased the risk of RAE (OR 2.42, 95% CI 1.29-4.72; p = 0.007) in deep ICH, whereas in lobar ICH results were nonsignificant for HE (OR 0.91, 95% CI 0.34-2.41; p = 0.9). Intensive BP reduction was not significantly associated with 90-day unfavorable functional outcome in either deep (OR 1.03, 95% CI 0.71-1.51; p = 0.9) or lobar (OR 0.97, 95% CI 0.31-2.95; p = 0.9) ICH.

Conclusions: In this exploratory analysis of the ATACH-2 study, intensive BP reduction was associated with reduced risk of HE and increased risk of RAE in deep but not lobar ICH. These results emphasize the need for a better understanding of the biological differences in ICH, which may have therapeutic implications.

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大叶性和深部脑出血对血压降低的不同反应。

背景：强化降压（BP）可能对急性脑出血（ICH）患者有益，但尚不清楚这些益处是否同样适用于大叶性和深部脑出血患者。我们的目的是评估与大叶性脑出血患者相比，深度脑出血患者强化降压对血肿扩张（HE）、90天功能结局和肾脏不良事件（RAEs）的影响。方法：这是一项对抗高血压治疗急性脑出血II （ATACH-2）随机临床试验的探索性事后分析，该试验研究了急性自发性脑出血后4.5小时强化降压（收缩压110-139毫米汞柱）与标准降压（收缩压140-179毫米汞柱）的疗效。我们的研究终点是HE（基线至24小时血肿量增加6 mL）、90天功能结局（改良Rankin量表评分0-3比4-6）和RAEs。结果：在1000名ATACH-2参与者中，只有875名（87.5%）参与者有完整的神经影像学资料（778名[89%]深叶，97名[11%]大叶，平均年龄62岁，男性62%）。多变量logistic回归结果显示，强化降压可降低HE发病风险(优势比[OR] 0.60, 95%可信区间[CI] 0.38-0.93；p = 0.024)， RAE风险增加(OR 2.42, 95% CI 1.29-4.72；p = 0.007)，而在大叶性脑出血中，HE的结果无统计学意义(OR 0.91, 95% CI 0.34-2.41；p = 0.9)。强化降压与90天内深部的不良功能结局无显著相关性(OR 1.03, 95% CI 0.71-1.51；p = 0.9)或大叶(or 0.97, 95% CI 0.31-2.95；p = 0.9) ICH。结论：在这项对ATACH-2研究的探索性分析中，深度脑出血（而非大叶脑出血）的深度血压降低与HE风险降低和RAE风险增加相关。这些结果强调需要更好地了解脑出血的生物学差异，这可能具有治疗意义。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurocritical Care 医学-临床神经学

CiteScore

7.40

自引率

8.60%

发文量

221

审稿时长

4-8 weeks

期刊介绍： Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.