Trial reportNeurology2025
Optimal Magnitude of Blood Pressure Reduction and Hematoma Growth and Functional Outcomes in Intracerebral Hemorrhage.
Trial report in Neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01176565 (Antihypertensive Treatment of Acute Cerebral Hemorrhage), which is not on this map. Cited by 9 papers, 2 of them syntheses that pooled it.
What it found
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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
Who cites it
9 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- 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
- 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
- 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
- Influencing factors and predictive model for in-hospital complications in patients with spontaneous intracerebral hemorrhage: A single-center retrospective study.Neurosurgical review · 2026Article
- Prehospital intensive blood pressure management in intracerebral hemorrhage: current evidence, controversies, and future directions.Frontiers in medicine · 2026Review
- Machine learning-based prediction of acute kidney injury after intracerebral hemorrhage: Comparison of multiple model approaches.Medicine · 2025Article
- Quantitative Shape Irregularity and Density Heterogeneity Predict Hematoma Expansion in Patients With Intracerebral Hemorrhage.Annals of clinical and translational neurology · 2025Article
- Association between serum potassium levels and haematoma expansion in intracerebral hemorrhage: a retrospective cohort study.Frontiers in neurologyArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors.
Funding
Abstract
BACKGROUND AND
objectivesEarly 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.
methodsWe performed a 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. Poor functional outcome was defined as the modified Rankin Scale score at 3-6 and hematoma expansion (HE) as a relative increase of >33% from baseline to 24 hours. Multivariable logistic regression assessed associations between SBP reduction and outcomes.
resultsOur study included 925 patients, of whom 360 (38.9%) were female. The median age was 62 years (IQR: 53-71). The median hematoma volume was 10.2 mL (IQR: 5.1-18.4), and the median magnitude of SBP reduction was 68 mm Hg (IQR: 48-88). Of those, 209 (22.6%) experienced HE, 122 (13.2%) experienced acute kidney injury (AKI), and 516 (55.8%) had poor outcome. Hematoma expansion decreased linearly as the magnitude of blood pressure reduction increased in 5 SBP reduction groups ( DISCUSSION: Targeting a SBP reduction within the range of 55-85 mm Hg during the first 2 hours seems to be associated with optimal outcomes in patients with mild-to-moderate ICH, balancing the need to limit hematoma growth while avoiding adverse effect. Further study focusing on severe ICH is warranted. TRIAL REGISTRATION INFORMATION: Clinical trial registration number: NCT01176565. CLASSIFICATION OF EVIDENCE: This post hoc analysis of the ATACH-2 trial provides Class III evidence that SBP reduction of 55-85 mm Hg during the initial 2 hours is associated with lower frequency of HE and better functional outcomes in patients with acute cerebral hemorrhage.
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