Tuesday, July 26, 2016

BP in Brain Bleeds (ATACH 2)

SCANCRIT - Posted on July 25, 2016 - By K
"A trial called ATACH-2 (Antihypertensive Treatment of Acute Cerebral Hemorrhage II), recently published inNEJM, is likely to temper the enthusiasm for aggressively lowering blood pressure in patients with intracranial bleeds...
Take-home message
ATACH-2 is similar to the previous INTERACT2 trial. INTERACT 2 could display a marginal tendency towards benefit with aggressive treatment. ATACH-2 builds on that as the researchers recruited patients with higher BPs and started treating earlier (4,5 vs 6h), hoping to amplify the trend seen in INTERACT2. Unfortunately, ATACH-2 could demonstrate no incremental benefit.
For me this means I will keep treating high blood pressures in patients with intracranial bleeds, perhaps aiming for the upper normal range. Not because I think it will improve neurological outcome but out of concern for other organ systems. These patients are often old and have comorbidities and might not tolerate high BPs for long."