Author Interviews, Blood Pressure - Hypertension, Brigham & Women's - Harvard, JAMA, Stroke / 16.04.2018
With Brain Microbleeds, Can Patients Tolerate Lower Blood Pressure?
MedicalResearch.com Interview with:
Dr. Joshua Goldstein MD, PhD
J. Philip Kistler Stroke Research Center
Division of Neurocritical Care and Emergency Neurology, Department of Neurology MGH
Harvard Medical School, Boston Department of Emergency Medicine
Massachusetts General Hospital
for the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) and the Neurological Emergencies Treatment Trials (NETT) Network Investigators
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: It’s hard to know how aggressively to lower blood pressure in acute intracerebral hemorrhage (ICH). Randomized controlled trials have been conflicting. We thought that we could use the presence of severe small vessel disease (SVD) - manifested by microbleeds seen on brain magnetic resonance imaging (MRI) – to guide treatment decisions. On the one hand, those with severe SVD may be most vulnerable to continued bleeding, and specifically need more intensive blood pressure lowering. On the other hand, if they have impaired regulation of cerebral blood flow, they might be harmed by rapid drops in blood pressure, and maybe we have to be more careful with them.
To answer this, we performed a subgroup analysis of the multi-centre ATACH-2 clinical trial of intensive blood pressure lowering. This was the first study to assess the effect of randomized acute stroke treatment on patients with more severe SVD, manifested by microbleeds. We found that no matter what your small vessel disease burden on MRI, you’ll respond the same to early blood pressure management.
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