Blood Pressure-Attained Analysis of ATACH 2 Trial

Background and Purpose We compared the rates of death or disability, defined by modified Rankin Scale score of 4 to 6, at 3 months in patients with intracerebral hemorrhage according to post-treatment systolic blood pressure (SBP)-attained status. Methods We divided 1000 subjects with SBP 180 mmHg who were randomized within 4.5 hours of symptom onset as follows: SBP <140 mmHg achieved or not achieved within 2 hours; subjects in whom SBP <140 mmHg was achieved within 2 hours were further divided: SBP <140 mmHg for 21 to 22 hours (reduced and maintained) or SBP was 140 mmHg for at least 2 hours during the period between 2 and 24 hours (reduced but not maintained). Results Compared with subjects without reduction of SBP <140 mmHg within 2 hours, subjects with reduction and maintenance of SBP <140 mmHg within 2 hours had a similar rate of death or disability (relative risk of 0.98; 95% confidence interval, 0.74-1.29). The rates of neurological deterioration within 24 hours were significantly higher in reduced and maintained group (10.4%; relative risk, 1.98; 95% confidence interval, 1.08-3.62) and in reduced but not maintained group (11.5%; relative risk, 2.08; 95% confidence interval, 1.15-3.75) compared with reference group. The rates of cardiac-related adverse events within 7 days were higher among subjects with reduction and maintenance of SBP <140 mmHg compared to subjects without reduction (11.2% versus 6.4%). Conclusions No decline in death or disability but higher rates of neurological deterioration and cardiac-related adverse events were observed among intracerebral hemorrhage subjects with reduction with and without maintenance of intensive SBP goals. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01176565.