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学科主题: 临床医学
题名:
Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral Hemorrhage
作者: Anderson, Craig S.1,3; Heeley, Emma1; Huang, Yining7; Wang, Jiguang8; Stapf, Christian11,12; Delcourt, Candice1,3; Lindley, Richard1; Robinson, Thompson13,14; Lavados, Pablo15,16; Neal, Bruce1; Hata, Jun1,17; Arima, Hisatomi1; Parsons, Mark4; Li, Yuechun9; Wang, Jinchao10; Heritier, Stephane1; Li, Qiang1; Woodward, Mark1,18; Simes, R. John2; Davis, Stephen M.5,6; Chalmers, John1; INTERACT2 Investigators
刊名: NEW ENGLAND JOURNAL OF MEDICINE
发表日期: 2013-06-20
DOI: 10.1056/NEJMoa1214609
卷: 368, 期:25, 页:2355-2365
收录类别: SCI
文章类型: Article
WOS标题词: Science & Technology
类目[WOS]: Medicine, General & Internal
研究领域[WOS]: General & Internal Medicine
关键词[WOS]: ASSOCIATION/AMERICAN-STROKE-ASSOCIATION ; ACUTE ISCHEMIC-STROKE ; CONTROLLED-TRIAL ; MANAGEMENT ; REDUCTION ; GROWTH ; HEMATOMA ; DETERMINANTS ; GUIDELINES ; MORTALITY
英文摘要:

Background

Whether rapid lowering of elevated blood pressure would improve the outcome in patients with intracerebral hemorrhage is not known.

Methods

We randomly assigned 2839 patients who had had a spontaneous intracerebral hemorrhage within the previous 6 hours and who had elevated systolic blood pressure to receive intensive treatment to lower their blood pressure (with a target systolic level of <140 mm Hg within 1 hour) or guideline-recommended treatment (with a target systolic level of <180 mm Hg) with the use of agents of the physician′s choosing. The primary outcome was death or major disability, which was defined as a score of 3 to 6 on the modified Rankin scale (in which a score of 0 indicates no symptoms, a score of 5 indicates severe disability, and a score of 6 indicates death) at 90 days. A prespecified ordinal analysis of the modified Rankin score was also performed. The rate of serious adverse events was compared between the two groups.

Results

Among the 2794 participants for whom the primary outcome could be determined, 719 of 1382 participants (52.0%) receiving intensive treatment, as compared with 785 of 1412 (55.6%) receiving guideline-recommended treatment, had a primary outcome event (odds ratio with intensive treatment, 0.87; 95% confidence interval [CI], 0.75 to 1.01; P = 0.06). The ordinal analysis showed significantly lower modified Rankin scores with intensive treatment (odds ratio for greater disability, 0.87; 95% CI, 0.77 to 1.00; P = 0.04). Mortality was 11.9% in the group receiving intensive treatment and 12.0% in the group receiving guideline-recommended treatment. Nonfatal serious adverse events occurred in 23.3% and 23.6% of the patients in the two groups, respectively.

Conclusions

In patients with intracerebral hemorrhage, intensive lowering of blood pressure did not result in a significant reduction in the rate of the primary outcome of death or severe disability. An ordinal analysis of modified Rankin scores indicated improved functional outcomes with intensive lowering of blood pressure.

语种: 英语
所属项目编号: 571281 ; 512402 ; 1004170
项目资助者: National Health and Medical Research Council of Australia ; National Health and Medical Research Council (NHMRC) of Australia ; Australian Research Council ; High Blood Pressure Research Council of Australia ; Osaka Pharmaceuticals ; Novartis ; Omron Healthcare ; Pfizer ; Takeda ; AD Pharma ; Servier ; Lundbeck ; BMJ ; Bristol-Myers Squibb ; Boehringer Ingelheim ; Sanofi-Aventis ; EVER Neuro Pharma
WOS记录号: WOS:000320601700005
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/62376
Appears in Collections:北京大学第一临床医学院_神经内科_期刊论文

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作者单位: 1.Royal Prince Alfred Hosp, Dept Neurol, Sydney, NSW 2050, Australia
2.Univ Melbourne, Melbourne, Vic, Australia
3.Peking Univ First Hosp, Dept Neurol, Beijing, Peoples R China
4.Yutian Cty Hosp, Dept Neurol, Tangshan, Hebei, Peoples R China
5.Hop Paris, Hop Lariboisiere, Dept Neurol, Paris, France
6.Univ Chile, Santiago, Chile
7.Johns Hopkins Univ, Dept Epidemiol, Baltimore, MD USA
8.Univ Sydney, George Inst Global Hlth, Sydney, NSW 2006, Australia
9.Univ Sydney, Natl Hlth & Med Res Council Clin Trials Ctr, Sydney, NSW 2006, Australia
10.Univ Newcastle, John Hunter Hosp, Dept Neurol, Newcastle, NSW 2300, Australia
11.Univ Melbourne, Royal Melbourne Hosp, Melbourne Brain Ctr, Melbourne, Vic 3050, Australia
12.Shanghai Jiao Tong Univ, Rui Jin Hosp, Shanghai Inst Hypertens, Shanghai, Peoples R China
13.Yutian Cty Hosp, Baotou Cent Hosp, Dept Neurol, Tangshan, Hebei, Peoples R China
14.Univ Paris 04, DHU NeuroVasc Paris Sorbonne, Paris, France
15.Univ Leicester, Dept Cardiovasc Sci, Leicester, Leics, England
16.Univ Leicester, NIHR Biomed Res Unit Cardiovasc Sci, Leicester, Leics, England
17.Univ Desarrollo, Clin Alemana, Dept Med, Serv Neurol, Concepcion, Chile
18.Kyushu Univ, Grad Sch Med Sci, Dept Environm Med, Fukuoka 812, Japan

Recommended Citation:
Anderson, Craig S.,Heeley, Emma,Huang, Yining,et al. Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral Hemorrhage[J]. NEW ENGLAND JOURNAL OF MEDICINE,2013,368(25):2355-2365.
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