Optimal Blodtryksreduktion og Resultater ved Intrakraniel Blødning
Tidlig intensiv reduktion af systolisk blodtryk (SBP) er en lovende strategi ved intracerebral hæmoragi (ICH), men den optimale reduktionsgrad inden for de første 2 timer er usikker. Denne undersøgelse har til formål at bestemme den optimale SBP-reduktionsgrad for at maksimere fordelene hos patienter, der deltager i ATACH-2-studiet [source_link].
Vi udførte en post hoc-analyse af ATACH-2-studiet, hvor deltagere med en initial SBP ≥180 mm Hg blev randomiseret inden for 4,5 timer efter symptomdebut. Deltagerne blev tildelt enten intensiv eller standard behandling. Reduktionsgraden for SBP blev beregnet som admissions-SBP minus minimum-SBP efter 2 timer. Deltagerne blev inddelt i fem grupper baseret på reduktionsgrad: 33% fra baseline til 24 timer. Multivariable logistisk regression blev anvendt til at vurdere sammenhængen mellem SBP-reduktion og udfald.
Studiet omfattede 925 patienter, hvoraf 360 (38,9%) var kvinder, med en medianalder på 62 år. Den mediane hæmatomvolumen var 10,2 mL, og den mediane SBP-reduktion var 68 mm Hg. Hæmatomudvidelse faldt lineært med stigende SBP-reduktion. Efter justering for confoundere var en større grad af SBP-reduktion (≥70 mm Hg) forbundet med en lavere risiko for HE, mens en reduktion ≥55 mm Hg var associeret med bedre funktionelle udfald. En reduktion ≥85 mm Hg øgede derimod risikoen for akut nyreskade (AKI) sammenlignet med <40 mm Hg.
Dette er en AI-genereret oversættelse og opsummering. Læseren bør konsultere den originale kilde for validering og ikke træffe kliniske beslutninger udelukkende på baggrund af dette resumé.
Læs hele studiet her: [source_link]
Læs hele studiet her: læs her
generer et html link ud fra Based on the information provided from the article published in *Neurology*, here’s how you could structure a code snippet that captures the significant details of the study, its findings, and context. This example could be utilized in a research database or for documentation purposes:
“`python
class Study:
def __init__(self, title, authors, publication_date, journal, doi, pmid, pmcid, background, methods, results, discussion, trial_registration, classification):
self.title = title
self.authors = authors
self.publication_date = publication_date
self.journal = journal
self.doi = doi
self.pmid = pmid
self.pmcid = pmcid
self.background = background
self.methods = methods
self.results = results
self.discussion = discussion
self.trial_registration = trial_registration
self.classification = classification
# Study details from the article
study = Study(
title=”Optimal Systolic Blood Pressure Reduction in Patients with Intracerebral Hemorrhage: A Post Hoc Analysis of the ATACH-2 Trial”,
authors=[
“Qi Li”, “Xinni Lv”, “Andrea Morotti”, “Adnan I Qureshi”,
“Dar Dowlatshahi”, “Guido J Falcone”, “Kevin Navin Sheth”,
“Ashkan Shoamanesh”, “Santosh B Murthy”, “Anand Viswanathan”,
“Joshua N Goldstein”
],
publication_date=”2025-03-11″,
journal=”Neurology”,
doi=”10.1212/WNL.0000000000213412″,
pmid=”39913881″,
pmcid=”PMC11803522 (available on 2026-03-11)”,
background=”Early intensive systolic blood pressure (SBP) reduction is a promising strategy for intracerebral hemorrhage (ICH), but the optimal magnitude of reduction in the first 2 hours remains uncertain. This study aimed to determine the optimal SBP reduction magnitude to maximize benefit in patients enrolled in the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) trial.”,
methods=(
“Post hoc analysis of the ATACH-2 trial. Participants with baseline SBP ≥180 mm Hg were randomized within 4.5 hours from onset and assigned to the intensive or standard group. ”
“The magnitude of SBP reduction was calculated as admission SBP minus minimum SBP at 2 hours. Eligible participants were divided into 5 groups by 15 mm Hg stratum: ”
“<40, 40-55, 55-70, 70-85, and ≥85 mm Hg. Multivariable logistic regression assessed associations between SBP reduction and outcomes."
),
results=(
"Included 925 patients (38.9% female). Median age: 62 years. Median hematoma volume: 10.2 mL; median SBP reduction: 68 mm Hg. "
"209 (22.6%) experienced hematoma expansion (HE), 122 (13.2%) had acute kidney injury (AKI), and 516 (55.8%) had poor outcomes. "
"HE decreased linearly with SBP reduction (p < 0.001). SBP reduction ≥70 mm Hg was associated with lower HE; reduction ≥55 mm Hg linked to better outcomes (OR 0.49). "
"However, reduction ≥85 mm Hg increased AKI risk (OR 2.00)."
),
discussion=(
"Targeting an SBP reduction of 55-85 mm Hg during the first 2 hours is associated with optimal outcomes in patients with mild-to-moderate ICH, "
"balancing the need to limit hematoma growth while avoiding adverse effects. Further study focusing on severe ICH is warranted."
),
trial_registration="Clinical trial registration number: NCT01176565.",
classification="This post hoc analysis provides Class III evidence that SBP reduction of 55-85 mm Hg during the initial 2 hours is linked to lower frequency of HE and better functional outcomes in patients with acute cerebral hemorrhage."
)
# Display study information
print(f"Title: {study.title}")
print(f"Authors: {', '.join(study.authors)}")
print(f"Publication Date: {study.publication_date}")
print(f"Journal: {study.journal}")
print(f"DOI: {study.doi}")
print(f"PMID: {study.pmid}")
print(f"PMCID: {study.pmcid}")
print(f"Background: {study.background}")
print(f"Methods: {study.methods}")
print(f"Results: {study.results}")
print(f"Discussion: {study.discussion}")
print(f"Trial Registration: {study.trial_registration}")
print(f"Classification: {study.classification}")
“`
This Python code defines a `Study` class to encapsulate details of the research article, and creates an instance of the class using the information provided. It then prints out the study's details for review. You can customize or expand this structure to suit your needs for organizing research information.
# Optimal Blodtryksreduktion og Resultater ved Intrakraniel Blødning
Intrakraniel blødning (IB) er en alvorlig medicinsk tilstand, der opstår, når der er blødning inden for kraniet, hvilket kan føre til betydelige neurologiske skader eller død. En af de mest kritiske faktorer i behandlingen af intrakraniel blødning er håndteringen af blodtrykket. Optimal blodtryksreduktion spiller en afgørende rolle i at minimere komplikationerne og forbedre resultaterne for patienter, der lider af denne tilstand.
## Hvad er Intrakraniel Blødning?
Intrakraniel blødning kan opdeles i flere typer, herunder subaraknoidal blødning, intraparenkymal blødning og epidural blødning. Årsagerne kan variere fra traumer, højt blodtryk, aneurismer til koagulationsforstyrrelser. Symptomerne kan inkludere hovedpine, bevidsthedstab, anfald og neurologiske defekter, afhængigt af blødningens placering og omfang.
## Betydningen af Blodtryksreduktion
Ved intrakraniel blødning kan forhøjet blodtryk føre til yderligere blødning og forværre den eksisterende skade. Derfor er det essentielt at kontrollere blodtrykket hos patienter med denne tilstand. Optimal blodtryksreduktion sigter mod at stabilisere blodtrykket uden at kompromittere cerebral perfusion, som er den blodtilførsel, der er nødvendig for at opretholde hjernefunktion.
### Mål for Blodtryksreduktion
De nuværende retningslinjer anbefaler, at systolisk blodtryk skal holdes under 140 mmHg hos patienter med intrakraniel blødning. Dette mål kan variere afhængigt af patientens tilstand og blødningens sværhedsgrad. Det er vigtigt at undgå for hurtig reduktion af blodtrykket, da dette kan føre til hypoperfusion af hjernen og yderligere neurologisk skade.
## Behandlingsstrategier
Der er forskellige strategier til at opnå optimal blodtryksreduktion:
1. **Medikamentel Behandling**: Antihypertensive lægemidler som labetalol, nicardipin og enalapril anvendes ofte til at kontrollere blodtrykket. Valget af medicin afhænger af patientens individuelle profil og den kliniske situation.
2. **Overvågning**: Kontinuerlig overvågning af blodtryk og neurologisk status er afgørende. Dette kan involvere brugen af invasiv overvågning, hvis patientens tilstand er kritisk.
3. **Livsstilsændringer**: For patienter med kronisk hypertension kan livsstilsændringer, såsom kostændringer, reduktion af alkoholindtag og regelmæssig motion, spille en rolle i langtidshåndteringen af blodtrykket.
## Resultater ved Optimal Blodtryksreduktion
Forskning viser, at effektiv blodtrykskontrol kan forbedre resultaterne for patienter med intrakraniel blødning. Studier har vist, at patienter, der opnår og opretholder de anbefalede blodtryksmål, har en lavere risiko for neurologiske defekter og bedre overlevelsesrater. Derudover kan tidlig intervention og optimal blodtryksreduktion reducere behovet for kirurgiske indgreb og forbedre den generelle prognose.
## Konklusion
Optimal blodtryksreduktion er en vigtig komponent i behandlingen af intrakraniel blødning. Gennem effektiv medicinsk intervention og nøje overvågning kan sundhedspersonale minimere risikoen for yderligere skade og forbedre patienternes resultater. Det er afgørende, at behandlingsstrategier tilpasses den enkelte patients behov for at sikre bedst mulige udfald. Yderligere forskning er nødvendig for at fastslå de mest effektive metoder til blodtrykskontrol og for at forstå de langsigtede konsekvenser af intrakraniel blødning.
**Article Information:**
– **Title:** Neurology
– **Publication Date:** March 11, 2025
– **Volume and Issue:** 104(5): e213412
– **DOI:** [10.1212/WNL.0000000000213412](https://doi.org/10.1212/WNL.0000000000213412)
– **Epub Date:** February 6, 2025
**Authors:**
1. Qi Li, Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
2. Xinni Lv, Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
3. Andrea Morotti, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
4. Adnan I Qureshi, Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO
5. Dar Dowlatshahi, Department of Medicine, Division of Neurology, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
6. Guido J Falcone, Department of Neurology, Yale School of Medicine, New Haven, CT
7. Kevin Navin Sheth, Division of Neurocritical Care and Emergency Neurology, Departments of Neurology and Neurosurgery, Yale School of Medicine, New Haven, CT
8. Ashkan Shoamanesh, Division of Neurology, Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
9. Santosh B Murthy, Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
10. Anand Viswanathan, Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, MA
11. Joshua N Goldstein, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
**Identifiers:**
– **PMID:** 39913881
– **PMCID:** PMC11803522 (available on March 11, 2026)
**Abstract:**
**Background and Objectives:**
The early reduction of systolic blood pressure (SBP) is a potential therapeutic approach for intracerebral hemorrhage (ICH), though the ideal degree of SBP reduction within the initial two hours is still not fully understood. This study sought to identify the optimal SBP reduction that would yield the most significant benefits for participants in the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) trial.
**Methods:**
This analysis is a post hoc examination of the ATACH-2 trial data. Participants with a baseline SBP of ≥180 mm Hg were randomized within 4.5 hours of symptom onset into either an intensive or standard treatment group. The reduction in SBP was calculated as the difference between the admission SBP and the minimum SBP observed at 2 hours. Participants were categorized into five groups based on SBP reduction ranges: 33% from baseline to 24 hours. Multivariable logistic regression was utilized to evaluate the relationships between SBP reduction and various outcomes.
**Results:**
A total of 925 patients were included in the analysis, with 360 (38.9%) being female. The median patient age was 62 years (IQR: 53-71) and the median hematoma volume was 10.2 mL (IQR: 5.1-18.4). The median SBP reduction recorded was 68 mm Hg (IQR: 48-88). Out of the cohort, 209 (22.6%) encountered HE, 122 (13.2%) suffered from acute kidney injury (AKI), and 516 (55.8%) experienced poor outcomes. An inverse relationship was noted between the degree of SBP reduction and the occurrence of HE across the five SBP reduction categories (p < 0.001). After adjusting for confounding variables, it was found that a greater SBP reduction (≥70 mm Hg) correlated with a lower likelihood of HE, while a reduction of ≥55 mm Hg was linked to improved functional outcomes (odds ratio [OR] 0.49, 95% CI 0.28-0.85). Conversely, reductions of ≥85 mm Hg were associated with an increased risk of AKI compared to reductions of <40 mm Hg (OR, 2.00; 95% CI 1.01-3.94).
**Discussion:**
Aiming for an SBP reduction of 55-85 mm Hg in the first two hours appears to optimize outcomes for patients with mild-to-moderate ICH by mitigating hematoma growth while minimizing adverse effects. Further investigations focusing on patients with severe ICH are recommended.
**Trial Registration Information:**
Clinical trial registration number: NCT01176565.
**Classification of Evidence:**
This post hoc analysis of the ATACH-2 trial offers Class III evidence that SBP reduction within the 55-85 mm Hg range during the first 2 hours correlates with a lower incidence of HE and improved functional outcomes in patients with acute cerebral hemorrhage.
**Publication Types:**
– Randomized Controlled Trial
**MeSH Terms:**
– Aged
– Antihypertensive Agents* / therapeutic use
– Blood Pressure* / drug effects
– Blood Pressure* / physiology
– Cerebral Hemorrhage* / complications
– Cerebral Hemorrhage* / drug therapy
– Female
– Hematoma* / drug therapy
– Humans
– Hypertension / complications
– Hypertension / drug therapy
– Male
– Middle Aged
– Treatment Outcome
**Substances:**
– Antihypertensive Agents
**Title:** Optimal Systolic Blood Pressure Reduction in Intracerebral Hemorrhage: Insights from the ATACH-2 Trial
**Source:** Neurology. 2025 Mar 11;104(5):e213412. doi: 10.1212/WNL.0000000000213412. Epub 2025 Feb 6.
—
**Authors:**
– Qi Li, 1
– Xinni Lv, 2
– Andrea Morotti, 3
– Adnan I Qureshi, 4
– Dar Dowlatshahi, 5
– Guido J Falcone, 6
– Kevin Navin Sheth, 7
– Ashkan Shoamanesh, 8
– Santosh B Murthy, 9
– Anand Viswanathan, 10
– Joshua N Goldstein, 11
**Affiliations:**
1. Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
2. Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
3. Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy.
4. Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO.
5. Department of Medicine, Division of Neurology, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada.
6. Department of Neurology, Yale School of Medicine, New Haven, CT.
7. Division of Neurocritical Care and Emergency Neurology, Departments of Neurology and Neurosurgery, Yale School of Medicine, New Haven, CT.
8. Division of Neurology, Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
9. Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY.
10. Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, MA.
11. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston.
**PMID:** 39913881
**PMCID:** PMC11803522 (available on 2026-03-11)
**DOI:** 10.1212/WNL.0000000000213412
—
**Abstract:**
**Background and Objectives:**
The reduction of early systolic blood pressure (SBP) is considered a promising approach for managing intracerebral hemorrhage (ICH), yet the ideal extent of SBP reduction within the initial 2 hours remains ambiguous. This study aimed to identify the optimal SBP reduction magnitude to enhance patient outcomes in the context of the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) trial.
**Methods:**
This analysis was derived from the ATACH-2 trial. Participants with a baseline SBP of ≥180 mm Hg were randomized within 4.5 hours post-onset and categorized into intensive or standard treatment groups. The SBP reduction was calculated as the difference between admission SBP and the lowest SBP recorded at 2 hours. Participants were segmented into 5 categories based on SBP reduction: 33% from baseline to 24 hours. Multivariable logistic regression was employed to evaluate the relationships between SBP reduction and patient outcomes.
**Results:**
The study analyzed 925 patients, with 360 (38.9%) being female. The median age was 62 years (IQR: 53-71), median hematoma volume was 10.2 mL (IQR: 5.1-18.4), and the median SBP reduction was 68 mm Hg (IQR: 48-88). Among the participants, 209 (22.6%) experienced HE, 122 (13.2%) had acute kidney injury (AKI), and 516 (55.8%) faced poor outcomes. There was a significant linear decrease in hematoma expansion as the degree of SBP reduction increased across the 5 groups (p < 0.001). After adjusting for confounding variables, a greater SBP reduction (≥70 mm Hg) correlated with reduced HE risk, while a reduction of ≥55 mm Hg linked to lower odds of poor outcomes (odds ratio [OR] 0.49, 95% CI 0.28-0.85). However, a reduction of ≥85 mm Hg was associated with an increased risk of AKI compared to reductions of <40 mm Hg (OR, 2.00; 95% CI 1.01-3.94).
**Discussion:**
Aiming for an SBP reduction between 55-85 mm Hg within the first 2 hours appears to optimize outcomes for patients with mild-to-moderate ICH, effectively balancing the prevention of hematoma growth against the risk of adverse effects. Further research focusing on severe ICH cases is essential.
**Trial Registration Information:**
Clinical trial registration number: NCT01176565.
**Classification of Evidence:**
This post hoc analysis of the ATACH-2 trial provides Class III evidence indicating that an SBP reduction of 55-85 mm Hg during the initial 2 hours is associated with a decreased incidence of HE and improved functional outcomes in acute cerebral hemorrhage cases.
—
**Publication Types:**
– Randomized Controlled Trial
**MeSH Terms:**
– Aged
– Antihypertensive Agents* / therapeutic use
– Blood Pressure* / drug effects
– Blood Pressure* / physiology
– Cerebral Hemorrhage* / complications
– Cerebral Hemorrhage* / drug therapy
– Female
– Hematoma* / drug therapy
– Humans
– Hypertension / complications
– Hypertension / drug therapy
– Male
– Middle Aged
– Treatment Outcome
**Substances:**
– Antihypertensive Agents