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学科主题临床医学
Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral Hemorrhage
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
2013-06-20
DOI10.1056/NEJMoa1214609
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
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 ; 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
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
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 ; 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
引用统计
被引频次:428[WOS]   [WOS记录]     [WOS相关记录]
文献类型期刊论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/62376
专题北京大学第一临床医学院_神经内科
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
推荐引用方式
GB/T 7714
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.
APA Anderson, Craig S..,Heeley, Emma.,Huang, Yining.,Wang, Jiguang.,Stapf, Christian.,...&INTERACT2 Investigators.(2013).Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral Hemorrhage.NEW ENGLAND JOURNAL OF MEDICINE,368(25),2355-2365.
MLA Anderson, Craig S.,et al."Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral Hemorrhage".NEW ENGLAND JOURNAL OF MEDICINE 368.25(2013):2355-2365.
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