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MINNEAPOLIS – Standard blood pressure treatments were no less effective than intensive efforts in the emergency treatment of acute intracerebral hemorrhage, according to an international stroke study.
The report, published recently in the New England Journal of Medicine, notes that patients whose systolic blood pressure was reduced rapidly in emergency rooms to standard levels used to treat acute stroke – 140-179 mm Hg – fared as well as those patients whose blood pressure was intensively reduced to 110-139 mm Hg.
"For decades, doctors wondered whether intensive blood pressure management was more effective than standard treatment for controlling intracerebral hemorrhage," explained principal investigator Adnan I. Qureshi, MD, professor of neurology at the University of Minnesota in Minneapolis. "Our results may help patients and their doctors make better treatment decisions."
Results of past studies have been mixed on whether rapid, intensive blood pressure lowering is necessary to control hemorrhage, and the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH II) trial sought to resolve the issue.
For the study, 1,000 patients with elevated blood pressure were randomly assigned following their strokes to either standard or intensive blood pressure treatments used for acute stroke. All of the participants, averaging age 62, were treated within four and a half hours of a stroke at medical centers in the United States, Japan, Taiwan, China, South Korea, and Germany between May 2011 and September 2015.
Entering the trial with average systolic pressure of 200.6 mm Hg, the participants’ blood pressure level was lowered by intravenous injections of nicardipine.
Researchers report that the treatment goal was to reduce and maintain the hourly minimum systolic blood pressure from 140 to 179 mm Hg in the standard treatment group and from 110 to 139 mm Hg in the intensive treatment group throughout the period of 24 hours after randomization.
Results indicate that, among the 961 participants in whom the primary outcome — the proportion of patients who had moderately severe or severe disability or who had died — was ascertained, death or disability was observed in 186 participants (38.7%) in the intensive treatment group and in 181 (37.7%) in the standard treatment group.
Brain scans taken 24 hours after treatment showed no difference in the rates of hemorrhage growth between the two groups. After 90 days, the rate of death or severe disability was equal, about 38%, for either treatment. Patients in the intensive treatment group, however, had a slightly higher rate of serious adverse events in the 90 days following the stroke.
"Rapidly lowering blood pressure to normal levels may further damage the brain," Qureshi suggested in a press release from the National Institutes of Health, which funded the study. "The levels we used are tolerable for emergencies. Normal levels can be safely obtained gradually."