Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral HemorrhageReportar como inadecuado




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BackgroundWhether rapid lowering of elevated blood pressure would improve the outcome inpatients with intracerebral hemorrhage is not known.MethodsWe randomly assigned 2839 patients who had had a spontaneous intracerebralhemorrhage within the previous 6 hours and who had elevated systolic blood pressureto receive intensive treatment to lower their blood pressure with a target systoliclevel of <140 mm Hg within 1 hour or guideline-recommended treatment with atarget 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 scoreof 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.ResultsAmong the 2794 participants for whom the primary outcome could be determined,719 of 1382 participants 52.0% receiving intensive treatment, as compared with785 of 1412 55.6% receiving guideline-recommended treatment, had a primaryoutcome event odds ratio with intensive treatment, 0.87; 95% confidence intervalCI, 0.75 to 1.01; P = 0.06. The ordinal analysis showed significantly lower modifiedRankin 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 intensivetreatment 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 thetwo groups, respectively.ConclusionsIn patients with intracerebral hemorrhage, intensive lowering of blood pressuredid not result in a significant reduction in the rate of the primary outcome ofdeath or severe disability. An ordinal analysis of modified Rankin scores indicatedimproved functional outcomes with intensive lowering of blood pressure.Nota general

Artículo de publicación ISI



Autor: Anderson, Craig S.; - Heeley, Emma; - Huang, Yining; - Wang, Jiguang; - Stapf, Christian; - Delcourt, Candice; - Lindley, Richard

Fuente: http://repositorio.uchile.cl/



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