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Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage

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dc.contributor.author Anderson, Craig
dc.contributor.author Heeley, Emma
dc.contributor.author Huang, Yining
dc.contributor.author Wang, Jiguang
dc.contributor.author Stapf, Christian
dc.contributor.author Delcourt, Candice
dc.contributor.author Lindley, Richard
dc.contributor.author Robinson, Thompson
dc.contributor.author Lavados, Pablo
dc.contributor.author Neal, Bruce
dc.contributor.author Hata, Jun
dc.contributor.author Arima, Hisatomi
dc.contributor.author Parsons, Mark
dc.contributor.author Li, Yuechun
dc.contributor.author Wang, Jinchao
dc.contributor.author Heritier, Stephane
dc.contributor.author Li, Qiang
dc.contributor.author Woodward, Mark
dc.contributor.author Simes, John
dc.contributor.author Davis, Stephen
dc.contributor.author Chalmers, John
dc.date.accessioned 2017-04-10T14:56:02Z
dc.date.available 2017-04-10T14:56:02Z
dc.date.issued 2013
dc.identifier.citation N Engl J Med. 2013 Jun 20;368(25):2355-65 es_CL
dc.identifier.uri http://dx.doi.org/10.1056/NEJMoa1214609 es_CL
dc.identifier.uri http://hdl.handle.net/11447/1122
dc.description.abstract 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. (Funded by the National Health and Medical Research Council of Australia; INTERACT2 ClinicalTrials.gov number, NCT00716079.). es_CL
dc.format.extent 11 es_CL
dc.language.iso en_US es_CL
dc.publisher Massachusetts Medical Society es_CL
dc.subject Antihypertensive Agents/therapeutic use es_CL
dc.subject Cerebral Hemorrhage/complications es_CL
dc.subject Hypertension/drug therapy es_CL
dc.title Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage es_CL
dc.type Artículo es_CL


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