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Adnan I. Qureshi - One of the best experts on this subject based on the ideXlab platform.
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Outcomes of Intensive Systolic Blood Pressure Reduction in Patients With Intracerebral Hemorrhage and Excessively High Initial Systolic Blood Pressure: Post Hoc Analysis of a Randomized Clinical Trial.
JAMA Neurology, 2020Co-Authors: Adnan I. Qureshi, Wei Huang, Iryna Lobanova, William G. Barsan, Daniel F. Hanley, Chung Y. Hsu, Cheng-li Lin, Robert Silbergleit, Thorsten Steiner, Jose I. SuarezAbstract:Importance The safety and efficacy of intensive systolic Blood Pressure Reduction in patients with intracerebral hemorrhage who present with systolic Blood Pressure greater than 220 mm Hg appears to be unknown. Objective To evaluate the differential outcomes of intensive (goal, 110-139 mm Hg) vs standard (goal, 140-179 mm Hg) systolic Blood Pressure Reduction in patients with intracerebral hemorrhage and initial systolic Blood Pressure of 220 mm Hg or more vs less than 220 mm Hg. Design, Setting, and Participants This post hoc analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage-II trial was performed in November 2019 on data from the multicenter randomized clinical trial, which was conducted between May 2011 to September 2015. Patients with intracerebral hemorrhage and initial systolic Blood Pressure of 180 mm Hg or more, randomized within 4.5 hours after symptom onset, were included. Interventions Intravenous nicardipine infusion titrated to goals. Main Outcomes and Measures Neurological deterioration and hematoma expansion within 24 hours and death or severe disability at 90 days, plus kidney adverse events and serious adverse events until day 7 or hospital discharge. Results A total of 8532 patients were screened, and 999 individuals (mean [SD] age, 62.0 [13.1] years; 620 men [62.0%]) underwent randomization and had an initial SBP value. Among 228 participants with initial systolic Blood Pressures of 220 mm Hg or more, the rate of neurological deterioration within 24 hours was higher in those who underwent intensive (vs standard) systolic Blood Pressure Reduction (15.5% vs 6.8%; relative risk, 2.28 [95% CI, 1.03-5.07];P = .04). The rate of death and severe disability (39.0% vs 38.4%; relative risk, 1.02 [95% CI, 0.73-1.78];P = .92) was not significantly different between the 2 groups. There was a significantly higher rate of kidney adverse events in participants randomized to intensive systolic Blood Pressure Reduction (13.6% vs 4.2%; relative risk, 3.22 [95% CI, 1.21-8.56];P = .01), but no difference was observed in the rate of kidney serious adverse events. Conclusions and Relevance The higher rate of neurological deterioration within 24 hours associated with intensive treatment in patients with intracerebral hemorrhage and initial systolic Blood Pressure of 220 mm Hg or more, without any benefit in reducing hematoma expansion at 24 hours or death or severe disability at 90 days, warrants caution against generalization of recommendations for intensive systolic Blood Pressure Reduction.
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Ultra-Early Blood Pressure Reduction Attenuates Hematoma Growth and Improves Outcome in Intracerebral Hemorrhage.
Annals of neurology, 2020Co-Authors: Andrew D. Warren, Adnan I. Qureshi, Andrea Morotti, Guido J. Falcone, Kevin N. Sheth, Ashkan Shoamanesh, Dar Dowlatshahi, Anand Viswanathan, Joshua N. GoldsteinAbstract:Objective The aim was to investigate whether intensive Blood Pressure treatment is associated with less hematoma growth and better outcome in intracerebral hemorrhage (ICH) patients who received intravenous nicardipine treatment ≤2 hours after onset of symptoms. Methods A post-hoc exploratory analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) trial was performed. This was a multicenter, international, open-label, randomized clinical trial, in which patients with primary ICH were allocated to intensive versus standard Blood Pressure treatment with nicardipine ≤4.5 hours after onset of symptoms. We have included 913 patients with complete imaging and follow-up data in the present analysis. Results Among the 913 included patients, 354 (38.7%) had intravenous nicardipine treatment initiated within 2 hours. In this subgroup of patients treated within 2 hours, the frequency of ICH expansion was significantly lower in the intensive Blood Pressure Reduction group compared with the standard treatment group (p = 0.02). Multivariable analysis showed that ultra-early intensive Blood Pressure treatment was associated with a decreased risk of hematoma growth (odds ratio, 0.56; 95% confidence interval [CI], 0.34-0.92; p = 0.02), higher rate of functional independence (odds ratio, 2.17; 95% CI, 1.28-3.68; p = 0.004), and good outcome (odds ratio, 1.68; 95% CI, 1.01-2.83; p = 0.048) at 90 days. Ultra-early intensive Blood Pressure Reduction was associated with a favorable shift in modified Rankin Scale score distribution at 3 months (p = 0.04). Interpretation In a subgroup of ICH patients with elevated Blood Pressure given intravenous nicardipine ≤2 hours after onset of symptoms, intensive Blood Pressure Reduction was associated with reduced hematoma growth and improved functional outcome. ANN NEUROL 2020;88:388-395.
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Association of Intensive Blood Pressure Reduction with Risk of Hematoma Expansion in Patients with Deep Intracerebral Hemorrhage
JAMA neurology, 2019Co-Authors: Audrey C Leasure, Adnan I. Qureshi, Daniel F. Hanley, Joshua N. Goldstein, Santosh B. Murthy, Hooman Kamel, Daniel Woo, Wendy C. Ziai, Rustam Al-shahi Salman, Charles C. MatoukAbstract:Importance Hypertension is the strongest risk factor for spontaneous intracerebral hemorrhage (ICH) involving deep brain regions, but it appears to be unknown if intensive Blood Pressure Reduction in the acute care setting decreases hematoma expansion or improves outcomes in patients with deep ICH. Objective To determine whether intensive Blood Pressure Reduction is associated with decreased risk of hematoma expansion and changes in 90-day modified Rankin Scale scores and if these associations are modified by the specific deep-brain nuclei involved. Design, Setting, and Participants This study is an exploratory analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage–2 international, multicenter randomized clinical trial, which was conducted from May 2011 to September 2015, enrolled eligible patients with primary ICH, and followed up with them for 90 days. Patients who had ICH and complete neuroimaging data were included in the analysis. Data analysis was completed from July 2018 to December 2018. Exposures Participants were randomized to either intensive treatment (with a systolic Blood Pressure target of 110-139 mm Hg) or standard treatment (with a systolic Blood Pressure target of 140-179 mm Hg). Main Outcomes and Measures The main outcome was hematoma expansion, defined as an increase greater than 33% in hematoma volume between baseline and 24 hours. Functional outcome was evaluated 90 days after the ICH via the modified Rankin Scale. Results Of 1000 trial participants, 870 (87.0%) had deep ICH, of whom 780 (89.7%) had complete neuroimaging data (of 336 thalamic and 444 basal ganglia hemorrhages). The baseline characteristics of the intensive and standard treatment groups remained balanced in this subgroup of the original study. Intensive treatment was associated with a decreased risk of hematoma expansion in univariable analysis (odds ratio [OR], 0.62 [95% CI, 0.43-0.87];P = .006) and multivariable analysis (OR, 0.61 [95% CI, 0.42-0.88];P = .009). This association was modified by the specific deep location of the ICH (OR, 0.44 [95% CI, 0.22-0.96]; interactionP = .02), with stratified analyses showing a Reduction in risk of hematoma expansion with intensive vs standard treatment among basal ganglia ICH (OR, 0.44 [95% CI, 0.27-0.72];P = .001) but not thalamic ICH (OR, 0.91 [95% CI, 0.51-0.64];P = .76). Intensive treatment was not associated with an improvement in the modified Rankin Scale score distribution. Conclusions and Relevance Compared with standard treatment, intensive Blood Pressure treatment was associated with reduced hematoma expansion in deep ICH, specifically among basal ganglia hemorrhages.
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Systolic Blood Pressure Reduction and Risk of Acute Renal Injury in Patients with Intracerebral Hemorrhage
The American Journal of Medicine, 2012Co-Authors: Adnan I. Qureshi, Yuko Y. Palesch, Renee H. Martin, Jill Novitzke, Salvador Cruz Flores, As’ad Ehtisham, Joshua N. Goldstein, Jawad F. Kirmani, Haitham M. Hussein, M. Fareed K. SuriAbstract:Abstract Background Aggressive systolic Blood Pressure Reduction may precipitate acute renal injury because of underlying hypertensive nephropathy in patients with intracerebral hemorrhage. The study's objective was to determine the rate and determinants of acute renal injury during acute hospitalization among subjects with intracerebral hemorrhage using a post hoc analysis of a multicenter prospective study. Methods Subjects with intracerebral hemorrhage and elevated systolic Blood Pressure of 170 mm Hg or greater who presented within 6 hours of symptom onset and underwent treatment of acute hypertensive response and fluid management as per study and local protocols, respectively. Acute renal injury was defined post hoc using the criteria used in Acute Kidney Injury Network classifications within 72 hours of admission. Descriptive statistics and standard statistical tests were used to characterize and evaluate the effect of systolic Blood Pressure Reduction parameters (relative to initial systolic Blood Pressure) and average maximum hourly dose of nicardipine on the occurrence of acute renal injury. Results A total of 60 subjects were recruited (57% were men; mean age of 62.0±15.1 years). Five subjects (9%) had stage I acute renal injury according to the Acute Kidney Injury Network criteria. None of the subjects had stage II or III acute renal injury. The serum creatinine course for the first 3 days suggested that the peak elevation of creatinine was seen at 18, 30, 57, 58, and 71 hours after baseline measurements in these 5 subjects, all of which except for the first one were beyond the protocol-specified treatment period. The incidences of neurologic deterioration and symptomatic hematoma expansion were significantly greater in the subjects with stage I renal impairment. The systolic Blood Pressure Reduction parameters (in particular, the area under the curve depicting the 24-hour systolic Blood Pressure summary statistic) and the higher average maximum hourly nicardipine dose were strongly associated with stage I renal impairment. Conclusions Although acute renal injury is infrequent and mild among subjects with intracerebral hemorrhage undergoing systolic Blood Pressure Reduction, a trend in association between systolic Blood Pressure Reduction and renal impairment was observed in this small study. Therefore, it is important to carefully monitor the renal function when administering treatment to reduce systolic Blood Pressure in patients with intracerebral hemorrhage.
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Blood Pressure Reduction in secondary stroke prevention.
Continuum (Minneapolis Minn.), 2011Co-Authors: Adnan I. Qureshi, Biggya L. SapkotaAbstract:PURPOSE OF REVIEW: : Risk factor modification plays an important role in recurrent stroke prevention. These modifiable risk factors tend to cluster in stroke patients, but for a significant subgroup the only identifiable risk factor is high Blood Pressure or chronic hypertension. This article reviews the current evidence for management of Blood Pressure in secondary stroke prevention. RECENT FINDINGS: : Over the years, data from primary prevention trials have shown that antihypertensive drug treatment reduces the risk of first stroke by 32%. Similarly, various secondary prevention studies have shown a relative risk Reduction in recurrent strokes of up to 30%. These trials have also shown that the impact of Blood Pressure Reduction in stroke prevention is similar in patients with hypertension and patients without hypertension, and larger Reductions in systolic Blood Pressure were associated with greater Reduction in risk of recurrent stroke. SUMMARY: : Although it is clear from the current evidence that long-term Blood Pressure control is one of the most important interventions for secondary stroke prevention, the optimal management of Blood Pressure in the immediate poststroke period is not well defined.
Joshua N. Goldstein - One of the best experts on this subject based on the ideXlab platform.
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Ultra-Early Blood Pressure Reduction Attenuates Hematoma Growth and Improves Outcome in Intracerebral Hemorrhage.
Annals of neurology, 2020Co-Authors: Andrew D. Warren, Adnan I. Qureshi, Andrea Morotti, Guido J. Falcone, Kevin N. Sheth, Ashkan Shoamanesh, Dar Dowlatshahi, Anand Viswanathan, Joshua N. GoldsteinAbstract:Objective The aim was to investigate whether intensive Blood Pressure treatment is associated with less hematoma growth and better outcome in intracerebral hemorrhage (ICH) patients who received intravenous nicardipine treatment ≤2 hours after onset of symptoms. Methods A post-hoc exploratory analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) trial was performed. This was a multicenter, international, open-label, randomized clinical trial, in which patients with primary ICH were allocated to intensive versus standard Blood Pressure treatment with nicardipine ≤4.5 hours after onset of symptoms. We have included 913 patients with complete imaging and follow-up data in the present analysis. Results Among the 913 included patients, 354 (38.7%) had intravenous nicardipine treatment initiated within 2 hours. In this subgroup of patients treated within 2 hours, the frequency of ICH expansion was significantly lower in the intensive Blood Pressure Reduction group compared with the standard treatment group (p = 0.02). Multivariable analysis showed that ultra-early intensive Blood Pressure treatment was associated with a decreased risk of hematoma growth (odds ratio, 0.56; 95% confidence interval [CI], 0.34-0.92; p = 0.02), higher rate of functional independence (odds ratio, 2.17; 95% CI, 1.28-3.68; p = 0.004), and good outcome (odds ratio, 1.68; 95% CI, 1.01-2.83; p = 0.048) at 90 days. Ultra-early intensive Blood Pressure Reduction was associated with a favorable shift in modified Rankin Scale score distribution at 3 months (p = 0.04). Interpretation In a subgroup of ICH patients with elevated Blood Pressure given intravenous nicardipine ≤2 hours after onset of symptoms, intensive Blood Pressure Reduction was associated with reduced hematoma growth and improved functional outcome. ANN NEUROL 2020;88:388-395.
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Association of Intensive Blood Pressure Reduction with Risk of Hematoma Expansion in Patients with Deep Intracerebral Hemorrhage
JAMA neurology, 2019Co-Authors: Audrey C Leasure, Adnan I. Qureshi, Daniel F. Hanley, Joshua N. Goldstein, Santosh B. Murthy, Hooman Kamel, Daniel Woo, Wendy C. Ziai, Rustam Al-shahi Salman, Charles C. MatoukAbstract:Importance Hypertension is the strongest risk factor for spontaneous intracerebral hemorrhage (ICH) involving deep brain regions, but it appears to be unknown if intensive Blood Pressure Reduction in the acute care setting decreases hematoma expansion or improves outcomes in patients with deep ICH. Objective To determine whether intensive Blood Pressure Reduction is associated with decreased risk of hematoma expansion and changes in 90-day modified Rankin Scale scores and if these associations are modified by the specific deep-brain nuclei involved. Design, Setting, and Participants This study is an exploratory analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage–2 international, multicenter randomized clinical trial, which was conducted from May 2011 to September 2015, enrolled eligible patients with primary ICH, and followed up with them for 90 days. Patients who had ICH and complete neuroimaging data were included in the analysis. Data analysis was completed from July 2018 to December 2018. Exposures Participants were randomized to either intensive treatment (with a systolic Blood Pressure target of 110-139 mm Hg) or standard treatment (with a systolic Blood Pressure target of 140-179 mm Hg). Main Outcomes and Measures The main outcome was hematoma expansion, defined as an increase greater than 33% in hematoma volume between baseline and 24 hours. Functional outcome was evaluated 90 days after the ICH via the modified Rankin Scale. Results Of 1000 trial participants, 870 (87.0%) had deep ICH, of whom 780 (89.7%) had complete neuroimaging data (of 336 thalamic and 444 basal ganglia hemorrhages). The baseline characteristics of the intensive and standard treatment groups remained balanced in this subgroup of the original study. Intensive treatment was associated with a decreased risk of hematoma expansion in univariable analysis (odds ratio [OR], 0.62 [95% CI, 0.43-0.87];P = .006) and multivariable analysis (OR, 0.61 [95% CI, 0.42-0.88];P = .009). This association was modified by the specific deep location of the ICH (OR, 0.44 [95% CI, 0.22-0.96]; interactionP = .02), with stratified analyses showing a Reduction in risk of hematoma expansion with intensive vs standard treatment among basal ganglia ICH (OR, 0.44 [95% CI, 0.27-0.72];P = .001) but not thalamic ICH (OR, 0.91 [95% CI, 0.51-0.64];P = .76). Intensive treatment was not associated with an improvement in the modified Rankin Scale score distribution. Conclusions and Relevance Compared with standard treatment, intensive Blood Pressure treatment was associated with reduced hematoma expansion in deep ICH, specifically among basal ganglia hemorrhages.
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Author response: Blood Pressure Reduction and noncontrast CT markers of intracerebral hemorrhage expansion
Neurology, 2018Co-Authors: Andrea Morotti, Jonathan Rosand, Joshua N. GoldsteinAbstract:We thank Drs. Lattanzi and Silvestrini for their interest in our article.1 Increased Blood Pressure variability may lead to poor outcome after acute intracerebral hemorrhage (ICH) but a post hoc analysis of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 (INTERACT2) showed that this association was not mediated by an increased risk of ICH growth.2 Hematoma expansion is a very early event in the natural history of ICH and, therefore, we agree that time is a key factor. Ischemic stroke treatment in mobile stroke units reduces the time from symptom onset to treatment.3 Early identification and treatment of patients with ICH at high risk of hematoma growth may become feasible in the prehospital setting using mobile stroke units equipped with noncontrast CT (NCCT). In a previous analysis, we showed that intrahematoma hypodensities, timing of baseline NCCT, and presence of the CT angiography spot sign predicted ICH expansion independently from each other.4 Further studies are needed to investigate whether the integration of different imaging markers provides additional value in the identification of ICH patients at high risk of hemorrhage growth.
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Systolic Blood Pressure Reduction and Risk of Acute Renal Injury in Patients with Intracerebral Hemorrhage
The American Journal of Medicine, 2012Co-Authors: Adnan I. Qureshi, Yuko Y. Palesch, Renee H. Martin, Jill Novitzke, Salvador Cruz Flores, As’ad Ehtisham, Joshua N. Goldstein, Jawad F. Kirmani, Haitham M. Hussein, M. Fareed K. SuriAbstract:Abstract Background Aggressive systolic Blood Pressure Reduction may precipitate acute renal injury because of underlying hypertensive nephropathy in patients with intracerebral hemorrhage. The study's objective was to determine the rate and determinants of acute renal injury during acute hospitalization among subjects with intracerebral hemorrhage using a post hoc analysis of a multicenter prospective study. Methods Subjects with intracerebral hemorrhage and elevated systolic Blood Pressure of 170 mm Hg or greater who presented within 6 hours of symptom onset and underwent treatment of acute hypertensive response and fluid management as per study and local protocols, respectively. Acute renal injury was defined post hoc using the criteria used in Acute Kidney Injury Network classifications within 72 hours of admission. Descriptive statistics and standard statistical tests were used to characterize and evaluate the effect of systolic Blood Pressure Reduction parameters (relative to initial systolic Blood Pressure) and average maximum hourly dose of nicardipine on the occurrence of acute renal injury. Results A total of 60 subjects were recruited (57% were men; mean age of 62.0±15.1 years). Five subjects (9%) had stage I acute renal injury according to the Acute Kidney Injury Network criteria. None of the subjects had stage II or III acute renal injury. The serum creatinine course for the first 3 days suggested that the peak elevation of creatinine was seen at 18, 30, 57, 58, and 71 hours after baseline measurements in these 5 subjects, all of which except for the first one were beyond the protocol-specified treatment period. The incidences of neurologic deterioration and symptomatic hematoma expansion were significantly greater in the subjects with stage I renal impairment. The systolic Blood Pressure Reduction parameters (in particular, the area under the curve depicting the 24-hour systolic Blood Pressure summary statistic) and the higher average maximum hourly nicardipine dose were strongly associated with stage I renal impairment. Conclusions Although acute renal injury is infrequent and mild among subjects with intracerebral hemorrhage undergoing systolic Blood Pressure Reduction, a trend in association between systolic Blood Pressure Reduction and renal impairment was observed in this small study. Therefore, it is important to carefully monitor the renal function when administering treatment to reduce systolic Blood Pressure in patients with intracerebral hemorrhage.
Candice Delcourt - One of the best experts on this subject based on the ideXlab platform.
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significance of hematoma shape and density in intracerebral hemorrhage the intensive Blood Pressure Reduction in acute intracerebral hemorrhage trial study
Stroke, 2016Co-Authors: Candice Delcourt, Hisatomi Arima, Xia Wang, Christian Stapf, Thompson G. Robinson, Rustam Al-shahi Salman, Shoichiro Sato, Shihong Zhang, Leo Davies, Pablo M LavadosAbstract:Background and Purpose— In patients with acute intracerebral hemorrhage (ICH), the shape and density of the hematoma are associated with its subsequent growth, but the impact of these parameters on clinical outcome is uncertain. Methods— Baseline computed tomographic scans and clinical data were obtained in the Intensive Blood Pressure Reduction in Acute Intracerebral Hemorrhage Trial (INTERACT2). Three independent neurologists blind to clinical data assessed ICH for shape and density using a previously described scale. Shape was defined as irregular when the ICH had ≥2 extra lesions added to the ellipsoid-shaped ICH. Density was heterogeneous when there were ≥3 low-density lesions within the ICH. Outcome measures were death and major disability (modified Rankin scale score of 3–5), combined and separate at 90-day postrandomization. Multivariable logistic regression models were used to determine the significance of hematoma characteristics on outcome. Results— There were 2066 patient computed tomographic scans included in the analysis, with 46% and 38% having irregular and heterogeneous ICH, respectively. Irregular shape was independently associated with death/major disability (adjusted odds ratio, 1.60; 95% confidence interval [CI], 1.29–1.98) and major disability alone (adjusted odds ratio, 1.60; 95% CI, 1.31–1.95), but not with death alone (adjusted odds ratio, 0.97; 95% CI, 0.68–1.39). Heterogeneous density was not associated with clinical outcomes (adjusted odds ratio, 1.06; 95% CI, 0.85–1.33), 1.04 (95% CI, 0.73–1.48), and 1.14 (95% CI, 0.93–1.39), respectively, for death/major disability, death alone, and disability alone). Conclusions— Irregular shape, but not heterogeneous density, is independently associated with poor outcome after ICH. Clinical Trial Registration— URL: . Unique identifier: [NCT00716079][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00716079&atom=%2Fstrokeaha%2F47%2F5%2F1227.atom
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degree and timing of intensive Blood Pressure lowering on hematoma growth in intracerebral hemorrhage intensive Blood Pressure Reduction in acute cerebral hemorrhage trial 2 results
Stroke, 2016Co-Authors: Xia Wang, Candice Delcourt, Christian Stapf, Cheryl Carcel, Shoichiro Sato, Else Charlotte SandsetAbstract:Background and Purpose— Degree and timing of Blood Pressure (BP) lowering treatment in relation to hematoma growth were investigated in the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial-2 (INTERACT2). Methods— INTERACT2 was an international clinical trial of intensive (target systolic BP [SBP], Results— Greater SBP Reduction was associated with reduced hematoma growth (13.3, 5.0, and 3.0 mL for P trend 6 hours (5.4 mL). The smallest mean absolute hematoma growth (2.0 mL) was in those achieving target SBP 5 to 8 times versus 3 to 4 (3.1 mL) and 0 to 2 times (5.2 mL). Conclusions— Intensive BP lowering with greater SBP Reduction, which is achieved quickly and maintained consistently, seems to provide protection against hematoma growth for 24 hours. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00716079.
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prognostic significance of perihematomal edema in acute intracerebral hemorrhage pooled analysis from the intensive Blood Pressure Reduction in acute cerebral hemorrhage trial studies
Stroke, 2015Co-Authors: Hisatomi Arima, Emma Heeley, Candice Delcourt, Jie YangAbstract:Background and Purpose—Controversy exists over the prognostic significance of perihematomal edema (PHE) in intracerebral hemorrhage. We aimed to determine the association of early PHE and clinical outcome among participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) studies. Methods—Pooled analyses of computed tomographic substudies in the pilot phase (INTERACT1) and main phase (INTERACT2), both international, prospective, open, blinded end point, randomized controlled trials, of patients with spontaneous intracerebral hemorrhage (<6 hours) and elevated systolic Blood Pressure, randomly assigned to intensive (target systolic Blood Pressure, <140 mm Hg) or guideline-based (systolic Blood Pressure, <180 mm Hg) Blood-Pressure management. Substudy participants (n=1310; 346 INTERACT1, 964 INTERACT2) had blinded central analyses of digital images from standardized baseline and 24-hour computed tomography. Predictors of death or dependency (modified Rankin scale score...
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Magnitude of Blood Pressure Reduction and Clinical Outcomes in Acute Intracerebral Hemorrhage: Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial Study
Hypertension (Dallas Tex. : 1979), 2015Co-Authors: Xia Wang, Hisatomi Arima, Mark Woodward, Ji-guang Wang, Emma Heeley, Candice Delcourt, Yining Huang, Christian Stapf, Thompson G. Robinson, John ChalmersAbstract:Abstract— Evidence supports early intensive Blood Pressure (BP) lowering in acute intracerebral hemorrhage, but uncertainty persists over whether potential benefits and harms vary according to the magnitude of BP Reduction. We aimed to determine whether larger systolic BP (SBP) Reductions were associated with better outcomes in participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). INTERACT2 was an international, open, blinded end point, randomized controlled trial of patients with spontaneous intracerebral hemorrhage ( 0.30). Optimal recovery from intracerebral hemorrhage was observed in hypertensive patients who achieved the greatest SBP Reductions (≥20 mm Hg) in the first hour and maintained for 7 days. Clinical Trial Registration— URL: . Unique identifier: [NCT00716079][1]. # Novelty and Significance {#article-title-33} [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00716079&atom=%2Fhypertensionaha%2F65%2F5%2F1026.atom
Henrik Imberg - One of the best experts on this subject based on the ideXlab platform.
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predictors and correlates of systolic Blood Pressure Reduction with liraglutide treatment in patients with type 2 diabetes
Journal of Clinical Hypertension, 2019Co-Authors: Magnus Wijkman, Mary Dena, Sofia Dahlqvist, Sheyda Sofizadeh, Irl Hirsch, Jaakko Tuomilehto, Johan Mårtensson, Ole Torffvit, Henrik ImbergAbstract:Liraglutide is associated with Blood Pressure Reduction in patients with type 2 diabetes. However, it is not known whether this Blood Pressure Reduction can be predicted prior to treatment initiation, and to what extent it correlates with weight loss and with improved glycemic control during follow-up. We analyzed data from a double-blind, placebo-controlled trial, in which 124 insulin-treated patients with type 2 diabetes were randomized to liraglutide or placebo. We evaluated various baseline variables as potential predictors of systolic Blood Pressure (SBP) Reduction, and evaluated whether changes in SBP correlated with weight loss and with improved glycemic control. A greater Reduction in SBP among liraglutide-treated patients was predicted by higher baseline values of SBP (P < 0.0001) and diastolic Blood Pressure (P = 0.012), and by lower baseline values of mean glucose measured by continuous glucose monitoring (CGM; P = 0.044), and serum fasting C-peptide (P = 0.015). The regression coefficients differed significantly between the liraglutide group and the placebo group only for diastolic Blood Pressure (P = 0.037) and mean CGM (P = 0.021). During the trial period, SBP Reduction correlated directly with change in body weight and BMI, but not with change in HbA1c. We conclude that patients with lower mean CGM values at baseline responded to liraglutide with a larger Reduction in SBP, and that improved HbA1c during follow-up was not associated with Reductions of SBP. Our data suggest that some patients with type 2 diabetes may benefit from liraglutide in terms of weight and SBP Reduction.
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Predictors and correlates of systolic Blood Pressure Reduction with liraglutide treatment in patients with type 2 diabetes
Journal of clinical hypertension (Greenwich Conn.), 2018Co-Authors: Magnus Wijkman, Mary Dena, Sofia Dahlqvist, Sheyda Sofizadeh, Irl Hirsch, Jaakko Tuomilehto, Johan Mårtensson, Ole Torffvit, Henrik Imberg, Aso SaeedAbstract:Liraglutide is associated with Blood Pressure Reduction in patients with type 2 diabetes. However, it is not known whether this Blood Pressure Reduction can be predicted prior to treatment initiation, and to what extent it correlates with weight loss and with improved glycemic control during follow-up. We analyzed data from a double-blind, placebo-controlled trial, in which 124 insulin-treated patients with type 2 diabetes were randomized to liraglutide or placebo. We evaluated various baseline variables as potential predictors of systolic Blood Pressure (SBP) Reduction, and evaluated whether changes in SBP correlated with weight loss and with improved glycemic control. A greater Reduction in SBP among liraglutide-treated patients was predicted by higher baseline values of SBP (P
Hisatomi Arima - One of the best experts on this subject based on the ideXlab platform.
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significance of hematoma shape and density in intracerebral hemorrhage the intensive Blood Pressure Reduction in acute intracerebral hemorrhage trial study
Stroke, 2016Co-Authors: Candice Delcourt, Hisatomi Arima, Xia Wang, Christian Stapf, Thompson G. Robinson, Rustam Al-shahi Salman, Shoichiro Sato, Shihong Zhang, Leo Davies, Pablo M LavadosAbstract:Background and Purpose— In patients with acute intracerebral hemorrhage (ICH), the shape and density of the hematoma are associated with its subsequent growth, but the impact of these parameters on clinical outcome is uncertain. Methods— Baseline computed tomographic scans and clinical data were obtained in the Intensive Blood Pressure Reduction in Acute Intracerebral Hemorrhage Trial (INTERACT2). Three independent neurologists blind to clinical data assessed ICH for shape and density using a previously described scale. Shape was defined as irregular when the ICH had ≥2 extra lesions added to the ellipsoid-shaped ICH. Density was heterogeneous when there were ≥3 low-density lesions within the ICH. Outcome measures were death and major disability (modified Rankin scale score of 3–5), combined and separate at 90-day postrandomization. Multivariable logistic regression models were used to determine the significance of hematoma characteristics on outcome. Results— There were 2066 patient computed tomographic scans included in the analysis, with 46% and 38% having irregular and heterogeneous ICH, respectively. Irregular shape was independently associated with death/major disability (adjusted odds ratio, 1.60; 95% confidence interval [CI], 1.29–1.98) and major disability alone (adjusted odds ratio, 1.60; 95% CI, 1.31–1.95), but not with death alone (adjusted odds ratio, 0.97; 95% CI, 0.68–1.39). Heterogeneous density was not associated with clinical outcomes (adjusted odds ratio, 1.06; 95% CI, 0.85–1.33), 1.04 (95% CI, 0.73–1.48), and 1.14 (95% CI, 0.93–1.39), respectively, for death/major disability, death alone, and disability alone). Conclusions— Irregular shape, but not heterogeneous density, is independently associated with poor outcome after ICH. Clinical Trial Registration— URL: . Unique identifier: [NCT00716079][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00716079&atom=%2Fstrokeaha%2F47%2F5%2F1227.atom
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prognostic significance of perihematomal edema in acute intracerebral hemorrhage pooled analysis from the intensive Blood Pressure Reduction in acute cerebral hemorrhage trial studies
Stroke, 2015Co-Authors: Hisatomi Arima, Emma Heeley, Candice Delcourt, Jie YangAbstract:Background and Purpose—Controversy exists over the prognostic significance of perihematomal edema (PHE) in intracerebral hemorrhage. We aimed to determine the association of early PHE and clinical outcome among participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) studies. Methods—Pooled analyses of computed tomographic substudies in the pilot phase (INTERACT1) and main phase (INTERACT2), both international, prospective, open, blinded end point, randomized controlled trials, of patients with spontaneous intracerebral hemorrhage (<6 hours) and elevated systolic Blood Pressure, randomly assigned to intensive (target systolic Blood Pressure, <140 mm Hg) or guideline-based (systolic Blood Pressure, <180 mm Hg) Blood-Pressure management. Substudy participants (n=1310; 346 INTERACT1, 964 INTERACT2) had blinded central analyses of digital images from standardized baseline and 24-hour computed tomography. Predictors of death or dependency (modified Rankin scale score...
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Magnitude of Blood Pressure Reduction and Clinical Outcomes in Acute Intracerebral Hemorrhage: Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial Study
Hypertension (Dallas Tex. : 1979), 2015Co-Authors: Xia Wang, Hisatomi Arima, Mark Woodward, Ji-guang Wang, Emma Heeley, Candice Delcourt, Yining Huang, Christian Stapf, Thompson G. Robinson, John ChalmersAbstract:Abstract— Evidence supports early intensive Blood Pressure (BP) lowering in acute intracerebral hemorrhage, but uncertainty persists over whether potential benefits and harms vary according to the magnitude of BP Reduction. We aimed to determine whether larger systolic BP (SBP) Reductions were associated with better outcomes in participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). INTERACT2 was an international, open, blinded end point, randomized controlled trial of patients with spontaneous intracerebral hemorrhage ( 0.30). Optimal recovery from intracerebral hemorrhage was observed in hypertensive patients who achieved the greatest SBP Reductions (≥20 mm Hg) in the first hour and maintained for 7 days. Clinical Trial Registration— URL: . Unique identifier: [NCT00716079][1]. # Novelty and Significance {#article-title-33} [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00716079&atom=%2Fhypertensionaha%2F65%2F5%2F1026.atom
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Effects of Blood Pressure Reduction in Mild Hypertension: A Systematic Review and Meta-analysis
Annals of internal medicine, 2015Co-Authors: Johan Sundström, Hisatomi Arima, Rod Jackson, Fiona Turnbull, Kazem Rahimi, John Chalmers, Mark Woodward, Bruce NealAbstract:Background: Effects of Blood Pressure Reduction in persons with grade 1 hypertension are unclear. Purpose: To investigate whether pharmacologic Blood Pressure Reduction prevents cardiovascular even ...
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the effects of Blood Pressure Reduction and of different Blood Pressure lowering regimens on major cardiovascular events according to baseline Blood Pressure meta analysis of randomized trials
Journal of Hypertension, 2011Co-Authors: Sebastien Czernichow, Fiona Turnbull, Alberto Zanchetti, Federica Barzi, Toshiharu Ninomiya, Andre Pascal Kengne, Hiddo J L Heerspink, Vlado Perkovic, Rachel R Huxley, Hisatomi ArimaAbstract:Background The benefits of reducing Blood Pressure are well established, but there remains uncertainty about whether the magnitude of the effect varies with the initial Blood Pressure level. The objective was to compare the risk Reductions achieved by different Blood Pressure-lowering regimens among individuals with different baseline Blood Pressures. Methods Thirty-two randomized controlled trials were included and seven comparisons between different types of treatments were made. For each comparison, the primary prespecified analysis included calculation of summary estimates of effect using random-effects meta-analysis for major cardiovascular events in four groups defined by baseline SBP ( = 180 mmHg). Results There were 201 566 participants among whom 20 079 primary outcome events were observed. There was no evidence of differences in the proportionate risk Reductions achieved with different Blood Pressure-lowering regimens across groups defined according to higher or lower levels of baseline SBP (all P for trend >0.17). This finding was broadly consistent for comparisons of different regimens, for DBP categories, and for commonly used Blood Pressure cut-points. Conclusion It appears unlikely that the effectiveness of Blood Pressure-lowering treatments depends substantively patients in the trials contributing to these overviews had a history of hypertension or were receiving background Blood Pressure-lowering therapy, the findings suggest that additional Blood Pressure Reduction in hypertensive patients meeting initial Blood Pressure targets will produce further benefits. More broadly, the data are supportive of the utilization of Blood Pressure-lowering regimens in high-risk patients with and without hypertension. J Hypertens 29: 4-16 (C) 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.