Acute Cerebrovascular Conditions · Coagulopathy and Bleeding · Haemodynamics

ATACH II Trial – No Benefit From Aggressive BP-lowering in ICH

Published in NEJM 2016, the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-II) trial compared two BP-management regimes in intracerebral haemorrhage patients with hypertension (SBP>180 mmHg): Intensive lowering to SBP 110-139 mm Hg. vs. standard treatment to within the 140-179 mm Hg range.

The trial was discontinued early after an interim analysis showed no difference between the groups in any key endpoint. Even when adjusted for differences in a number of clinical characteristics, the study showed futility and was stopped after the recruitment of 1000 patients.

Interestingly, there was a significantly increased rate of renal adverse events in the intensive treatment group (9.0% vs. 4.0%, P=0.002). However, this did not translate into increased morbidity or mortality.

This study follows in the footsteps of INTERACT 2 (NEJM 2013). This trial failed to demonstrate any mortality benefit with rapid BP-lowering in hypertensive patients with ICH, but did show significantly improved modified Rankin scores in the intervention-group.

A bit more on BP-management and ICH here.

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