Trial reportThe New England journal of medicine2016
Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage.
Trial report in The New England journal of medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 5 registered trials, which are not on this map. Cited by 470 papers, 10 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH)-II: A Phase III Randomized Multicenter Clinical Trial of Blood Pressure Reduction for Hypertension in Acute Intracerebral Hemorrhage
Biologic Mechanisms of Early Exercise After Intracerebral Hemorrhage: a Pilot Randomized Controlled Trial of Cycle Ergometry
Proper Timing of Control of Hypertension and Outcome in Acute Spontaneous Intracerebral Hemorrhage.
Effectiveness of Intravenous Tranexamic Acid in Primary Cerebral Hemorrhage for Prevention of Hematoma Progression: Protocol for a Randomized, Double Blind Placebo-controlled Trial
Efficacy and Safety of an Early Intensive Blood Pressure-Lowering Strategy Using Remifentanil and Dexmedetomidine in Patients With Spontaneous Intracerebral Hemorrhage: A Multicenter, Prospective, Superiority, Randomized Controlled Trial
Who cites it
470 citing papers in PubMed, 10 syntheses or guidelines pooled it, 1,102 citations in OpenAlex.
- Blood Pressure Reduction Time Windows in Stroke: A Systematic Review and Network Meta-Analysis.Brain and behavior · 2026Pooled it
- 2025 update to European Stroke Organisation (ESO) guideline on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage.European stroke journal · 2026Guideline
- Executive Summary of the 2024 Philippine Clinical Practice Guidelines on the Diagnosis and Management of Acute Severe Blood Pressure Elevation.Journal of clinical hypertension (Greenwich, Conn.) · 2026Guideline
- Prehospital blood pressure lowering in acute hemorrhagic stroke: a systematic review and meta-analysis of randomized controlled clinical trials.European stroke journal · 2026Pooled it
- The Japanese Society of Hypertension Guidelines for the management of elevated blood pressure and hypertension 2025 (JSH2025).Hypertension research : official journal of the Japanese Society of Hypertension · 2026Guideline
- Acute kidney injury incidence and mortality following spontaneous intracerebral hemorrhage: a systematic review and meta-analysis.Frontiers in medicine · 2026Pooled it
- Intensive Blood Pressure Lowering for Intracerebral Hemorrhage: A Systematic Review and Updated Meta-analysis of Randomized Controlled Trials.Neurocritical care · 2025Pooled it
- Surgery for spontaneous supratentorial intracerebral haemorrhage.The Cochrane database of systematic reviews · 2025Pooled it
- Pooled it
- Early blood pressure management in hemorrhagic stroke: a meta-analysis.Journal of neurology · 2023Pooled it
- Identifying treatment-responsive patient subgroups in a neutral clinical trial of Intensive blood pressure reduction in acute intracerebral hemorrhage: A post hoc explainable machine learning analysis.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2026Trial
- Trial
- The Association between Hourly Systolic Blood Pressure Variability and Outcomes in Patients with Intracerebral Hemorrhage is Time-Dependent: Post-hoc Analysis of the ATACH-2 Trial.Neurocritical care · 2026Trial
- Blood pressure variability in the ATACH2 study: evaluating a target range.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Trial
- Clevidipine infusion for blood pressure management after successful revascularisation in acute ischaemic stroke: the CLEVER study.European stroke journal · 2026Trial
- Assessing the Clinical Relevance of Blood Pressure Measures in Spontaneous Intracerebral Hemorrhage: A Post Hoc Analysis of ATACH-2.Neurocritical care · 2025Trial
- Different Responses to Blood Pressure Reduction in Lobar and Deep Intracerebral Hemorrhage.Neurocritical care · 2025Trial
- Trial
- Optimal Magnitude of Blood Pressure Reduction and Hematoma Growth and Functional Outcomes in Intracerebral Hemorrhage.Neurology · 2025Trial
- Mechanistic Evaluation of Diffusion Weighted Hyperintense Lesions After Large Spontaneous Intracerebral Hemorrhage: A Subgroup Analysis of MISTIE III.Neurocritical care · 2024Trial
410 more citing papers are in PubMed but not listed here.
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Authors and funding
15 authors at 7 institutions in 6 countries.
Funding
Abstract
backgroundLimited data are available to guide the choice of a target for the systolic blood-pressure level when treating acute hypertensive response in patients with intracerebral hemorrhage.
methodsWe randomly assigned eligible participants with intracerebral hemorrhage (volume, <60 cm(3)) and a Glasgow Coma Scale (GCS) score of 5 or more (on a scale from 3 to 15, with lower scores indicating worse condition) to a systolic blood-pressure target of 110 to 139 mm Hg (intensive treatment) or a target of 140 to 179 mm Hg (standard treatment) in order to test the superiority of intensive reduction of systolic blood pressure to standard reduction; intravenous nicardipine to lower blood pressure was administered within 4.5 hours after symptom onset. The primary outcome was death or disability (modified Rankin scale score of 4 to 6, on a scale ranging from 0 [no symptoms] to 6 [death]) at 3 months after randomization, as ascertained by an investigator who was unaware of the treatment assignments.
resultsAmong 1000 participants with a mean (±SD) systolic blood pressure of 200.6±27.0 mm Hg at baseline, 500 were assigned to intensive treatment and 500 to standard treatment. The mean age of the patients was 61.9 years, and 56.2% were Asian. Enrollment was stopped because of futility after a prespecified interim analysis. The primary outcome of death or disability was observed in 38.7% of the participants (186 of 481) in the intensive-treatment group and in 37.7% (181 of 480) in the standard-treatment group (relative risk, 1.04; 95% confidence interval, 0.85 to 1.27; analysis was adjusted for age, initial GCS score, and presence or absence of intraventricular hemorrhage). Serious adverse events occurring within 72 hours after randomization that were considered by the site investigator to be related to treatment were reported in 1.6% of the patients in the intensive-treatment group and in 1.2% of those in the standard-treatment group. The rate of renal adverse events within 7 days after randomization was significantly higher in the intensive-treatment group than in the standard-treatment group (9.0% vs. 4.0%, P=0.002).
conclusionsThe treatment of participants with intracerebral hemorrhage to achieve a target systolic blood pressure of 110 to 139 mm Hg did not result in a lower rate of death or disability than standard reduction to a target of 140 to 179 mm Hg. (Funded by the National Institute of Neurological Disorders and Stroke and the National Cerebral and Cardiovascular Center; ATACH-2 ClinicalTrials.gov number, NCT01176565 .).
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.