Clocchiatti-Tuozzo Santiago, Rivier Cyprien A, Qureshi Adnan I, Renedo Daniela, Huo Shufan, Matouk Charles, Petersen Nils, de Havenon Adam, Sheth Kevin N, Rabinstein Alejandro A, Falcone Guido J, Hawkes Maximiliano A
Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA.
Neurocrit Care. 2025 Apr 28. doi: 10.1007/s12028-025-02269-2.
Intensive blood pressure (BP) reduction may benefit patients with acute intracerebral hemorrhage (ICH), but it is unknown if those benefits apply equally to patients with lobar and deep ICH. Our objective was to assess the impact of intensive BP reduction on hematoma expansion (HE), 90-day functional outcomes, and renal adverse events (RAEs) in patients with deep ICH compared with those with lobar ICH.
This was an exploratory, post hoc analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2) randomized clinical trial, which investigated the efficacy of intensive BP reduction (110-139 mm Hg systolic BP) versus standard (140-179 mm Hg systolic BP) reduction 4.5 h after acute spontaneous ICH. Our end points of interest were HE (> 6 mL increase in hematoma volume between baseline and 24 h), 90-day functional outcome (modified Rankin Scale score 0-3 vs. 4-6), and RAEs.
Of 1000 ATACH-2 participants, only 875 participants (87.5%) with complete neuroimaging data were included (778 [89%] deep and 97 [11%] lobar, mean age of 62 years, 62% male). Multivariable logistic regressions results showed that intensive BP reduction decreased the risk of HE (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.38-0.93; p = 0.024) and increased the risk of RAE (OR 2.42, 95% CI 1.29-4.72; p = 0.007) in deep ICH, whereas in lobar ICH results were nonsignificant for HE (OR 0.91, 95% CI 0.34-2.41; p = 0.9). Intensive BP reduction was not significantly associated with 90-day unfavorable functional outcome in either deep (OR 1.03, 95% CI 0.71-1.51; p = 0.9) or lobar (OR 0.97, 95% CI 0.31-2.95; p = 0.9) ICH.
In this exploratory analysis of the ATACH-2 study, intensive BP reduction was associated with reduced risk of HE and increased risk of RAE in deep but not lobar ICH. These results emphasize the need for a better understanding of the biological differences in ICH, which may have therapeutic implications.
强化降压可能使急性脑出血（ICH）患者获益，但尚不清楚这些益处是否同样适用于脑叶出血和深部脑出血患者。我们的目的是评估强化降压对深部脑出血患者与脑叶脑出血患者血肿扩大（HE）、90天功能结局及肾脏不良事件（RAE）的影响。
这是对急性脑出血降压治疗II（ATACH-2）随机临床试验的一项探索性事后分析，该试验研究了急性自发性脑出血后4.5小时强化降压（收缩压110 - 139 mmHg）与标准降压（收缩压140 - 179 mmHg）的疗效。我们感兴趣的终点是血肿扩大（基线至24小时血肿体积增加>6 mL）、90天功能结局（改良Rankin量表评分0 - 3分与4 - 6分）及肾脏不良事件。
在1000名ATACH-2参与者中，仅纳入了875名（87.5%）有完整神经影像学数据的参与者（778名[89%]深部脑出血患者和97名[11%]脑叶脑出血患者，平均年龄62岁，62%为男性）。多变量逻辑回归结果显示，强化降压降低了深部脑出血患者血肿扩大的风险（比值比[OR] 0.60，95%置信区间[CI] 0.38 - 0.93；p = 0.024），并增加了肾脏不良事件的风险（OR 2.42，95% CI 1.29 - 4.72；p = 0.007），而在脑叶脑出血患者中，血肿扩大的结果无统计学意义（OR 0.91，95% CI 0.34 - 2.41；p = 0.9）。强化降压与深部脑出血（OR 1.03，95% CI 0.71 - 1.51；p = 0.9）或脑叶脑出血（OR 0.97，95% CI 0.31 - 2.95；p = 0.9）患者90天不良功能结局均无显著关联。
在对ATACH-2研究的这项探索性分析中，强化降压与深部脑出血而非脑叶脑出血患者血肿扩大风险降低及肾脏不良事件风险增加相关。这些结果强调了更好地理解脑出血生物学差异的必要性，这可能具有治疗意义。
