Hypertension management in elderly with severe intracerebral hemorrhage

Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China. Department of Neurology, 215 Hospital of Shaanxi NI, Xianyang, 712021, China. Department of Neurology, Ankang Central Hospital, Ankang, 725000, China. Department of Neurology, Xianyang Central Hospital, Xianyang, 712000, China. Department of Neurology, Hanzhong Central Hospital, Hanzhong, 723000, China. Department of Neurology, Weinan Central Hospital, Weinan, 714000, China. Department of Neurology, Xi'an 141 Hospital, Xi'an, 710499, China. Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, China. Department of Neurology, Xi'an Gaoxin Hospital, Xi'an, 710075, China. Department of Neurology, Xi'an XD Group Hospital, Xi'an, 710077, China. Department of Neurology, Shangluo Central Hospital, Shangluo, 726000, China. Department of Neurology, Yulin No.2 Central Hospital, Yulin, 719000, China. Department of Neurology, Shaanxi Provincial People's Hospital, Xi'an, 710068, China. Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China. Department of Neurology, 521 Hospital of NORINCO Group, Xi'an, 710000, China. Department of Neurology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, 710021, China. Department of Neurology, Tongchuan People's Hospital, Tongchuan, China. The Shaanxi Cerebrovascular Disease Clinical Research Center, Xi'an, 710032, China.

Annals of clinical and translational neurology. 2021;8(10):2059–2069
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OBJECTIVE To explore the effect of individualized blood pressure (BP)-lowering treatment on the outcomes of elderly patients with severe intracerebral hemorrhage (ICH). METHODS We performed an exploratory analysis of Controlling Hypertension After Severe Cerebrovascular Event (CHASE) trial, which was a multicenter, randomized, controlled clinical trial. Patients with severe ischemic or hemorrhagic stroke (defined as GCS ≤ 12 or NIHSS ≥ 11) were randomized into individualized versus standard BP-lowering treatment in CHASE trial. In this exploratory analysis, patients with severe ICH were included. The primary outcome was the percentage of patients with 90-day functional independence defined as modified Rankin Scale (mRS) ≤2. RESULTS We included 242 patients with severe ICH in the present analysis, consisting of 142 patients aged <65 years and 100 patients aged ≥65 years. There were significant differences between patients aged ≥65 years and <65 years in the proportion of functional independence (47.9% vs. 15.0%, P < 0.001) and good outcome (73.9% vs. 50.0%, P < 0.001) at day 90. In patients aged ≥65 years, the adjusted individualized BP-lowering treatment had an unequivocal effect on the functional independence at day 90 (21.6% vs. 8.2%, odds ratio [OR]: 4.309, 95% confidence interval [CI]: 1.040-17.859, P = 0.044) and improved the neurological deficits at discharge (∆ NIHSS ≥ 4: 64.7% vs. 34.7%, OR: 4.300, 95% CI: 1.599-11.563, P = 0.004). INTERPRETATION Compared with the younger counterparts, the elderly patients (≥65 years) with acute severe ICH might benefit more from individualized BP-lowering treatment.
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Language : eng
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