Intensive BP reduction associated with smaller haematoma

Early use of intensive blood pressure (BP) reduction may reduce haematoma growth and improve outcomes in patients with fast-bleeding, spontaneous intracerebral haemorrhage (ICH). This was concluded from an exploratory analysis of data from the ATACH-2 randomised-controlled trial.

ICH patients with the highest risk of haematoma growth potentially benefit most from anti-expansion treatment, stated Prof. Qi Li (Chongqing Medical University, China) [1]. In the phase 3 ATACH-2 trial (NCT01176565), intensive BP lowering in ICH patients to achieve a target systolic value between 110–139 mmHg did not lower the death rate or disability compared with a standard BP reduction to 140–179 mmHg [2]. For this intervention to be effective, Prof Li suggested, “we have to do it early and fast.” The aim of the presented analysis was to determine whether intensive BP reduction benefits patients with fast-bleeding ICH and to evaluate the associations between fast-bleeding ICH, haematoma growth, and the outcome [1].

The study population consisted of 940 participants of the ATACH-2 trial. Fast-bleeding ICH was defined as an ICH volume/onset-to-CT time >5 mL/h; this definition was met by 567 of the 940 selected participants. Intensive BP reduction was found to attenuate haematoma growth in fast-bleeding ICH. Multivariable logistic regression analysis showed that the risk of haematoma expansion >33% was lowered in fast-bleeding patients (OR 0.58; 95% CI 0.39–0.85; P=0.006; see Table). In slow-bleeding patients, this was not the case (OR 0.97; 95% CI 0.57–1.65; P=0.909). In a subgroup of 266 (46.9%) fast-bleeding participants who presented early and could be treated within 2 hours, intensive BP lowering was associated with improved functional independence (OR 1.98; 95% CI 1.06–3.69; P=0.031).

Table: Intensive BP reduction attenuates haematoma growth in fast-bleeding ICH [1]

1. Adjusted for age, sex, systolic blood pressure, baseline ICH-volume, time from onset to CT.
2. Adjusted for age, sex, systolic blood pressure, baseline ICH-volume, presence of intraventricular haemorrhage, baseline Glasgow Coma Scale.

“These results support the hypothesis that early use of intensive BP reduction therapy reduces haematoma growth and improves outcomes in fast-bleeding patients,” Prof Li concluded. “Any therapy aimed at limiting haematoma growth, such as haemostatic therapy or reversal of anticoagulation, might also need to be applied to fast-bleeding patients. ICH patients presenting early, with a high ratio of initial ICH volume/time-to-presentation may specifically benefit from intensive BP reduction.”

1. Li Q, et al. Intensive blood pressure reduction attenuates hematoma growth in fast-bleeding intracerebral haemorrhage patients. EAN 2023 Annual Meeting, 1–4 July, Budapest, Hungary.
2. Qureshi AI, et al. N Engl J Med. 2016;375(11):1033–43.

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Posted on 7 September 202329 February 2024