TY - JOUR
T1 - Sex Differences in Blood Pressure-Lowering Therapy and Outcomes Following Intracerebral Hemorrhage
T2 - Results from ATACH-2
AU - Fukuda-Doi, Mayumi
AU - Yamamoto, Haruko
AU - Koga, Masatoshi
AU - Palesch, Yuko Y.
AU - Durkalski-Mauldin, Valerie L.
AU - Qureshi, Adnan I.
AU - Yoshimura, Sohei
AU - Okazaki, Shuhei
AU - Miwa, Kaori
AU - Okada, Yasushi
AU - Ueda, Toshihiro
AU - Okuda, Satoshi
AU - Nakahara, Jin
AU - Suzuki, Norihiro
AU - Toyoda, Kazunori
N1 - Funding Information:
Supported by grants from National Institute of Neurological Disorders and Stroke (NINDS; U01-NS062091, U01-NS061861, U01-NS059041), The Ministry of Education, Culture, Sports, Science and Technology, Grants-in-Aid for Scientific Research (KAKENHI; JP17H04308), and Japan Agency for Medical Research and Development (AMED; 20lk0201094h0002, 20lk0201109h0001).
Publisher Copyright:
© 2020 The Authors.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Background and Purpose: Evidence regarding sex differences in clinical outcomes and treatment effect following intracerebral hemorrhage is limited. Using the ATACH-2 trial (Antihypertensive Treatment in Intracerebral Hemorrhage-2) data, we explored whether sex disparities exist in outcomes and response to intensive blood pressure (BP)-lowering therapy. Methods: Eligible intracerebral hemorrhage subjects were randomly assigned to intensive (target systolic BP, 110-139 mm Hg) or standard (140-179 mm Hg) BP-lowering therapy within 4.5 hours after onset. Relative risk of death or disability corresponding to the modified Rankin Scale score of 4 to 6 was calculated, and interaction between sex and treatment was explored. Results: In total, 380 women and 620 men were included. Women were older, more prescribed antihypertensive drugs before onset, and had more lobar intracerebral hemorrhage than men. Hematoma expansion was observed less in women. After multivariable adjustment, the relative risk of death or disability in women was 1.19 (95% CI, 1.02-1.37, P=0.023). The relative risk of death or disability between intensive versus standard BP-lowering therapy was 0.91 (95% CI, 0.74-1.13) in women versus 1.13 (95% CI, 0.92-1.39) in men (P for interaction=0.11), with inconclusive Gail-Simmon test (P=0.16). Conclusions: Women had a higher risk of death or disability following intracerebral hemorrhage. The benefit of intensive BP-lowering therapy in women is inconclusive, consistent with the overall results of ATACH-2. Registration: URL: Https://www.clinicaltrials.gov. Unique identifier: NCT01176565.
AB - Background and Purpose: Evidence regarding sex differences in clinical outcomes and treatment effect following intracerebral hemorrhage is limited. Using the ATACH-2 trial (Antihypertensive Treatment in Intracerebral Hemorrhage-2) data, we explored whether sex disparities exist in outcomes and response to intensive blood pressure (BP)-lowering therapy. Methods: Eligible intracerebral hemorrhage subjects were randomly assigned to intensive (target systolic BP, 110-139 mm Hg) or standard (140-179 mm Hg) BP-lowering therapy within 4.5 hours after onset. Relative risk of death or disability corresponding to the modified Rankin Scale score of 4 to 6 was calculated, and interaction between sex and treatment was explored. Results: In total, 380 women and 620 men were included. Women were older, more prescribed antihypertensive drugs before onset, and had more lobar intracerebral hemorrhage than men. Hematoma expansion was observed less in women. After multivariable adjustment, the relative risk of death or disability in women was 1.19 (95% CI, 1.02-1.37, P=0.023). The relative risk of death or disability between intensive versus standard BP-lowering therapy was 0.91 (95% CI, 0.74-1.13) in women versus 1.13 (95% CI, 0.92-1.39) in men (P for interaction=0.11), with inconclusive Gail-Simmon test (P=0.16). Conclusions: Women had a higher risk of death or disability following intracerebral hemorrhage. The benefit of intensive BP-lowering therapy in women is inconclusive, consistent with the overall results of ATACH-2. Registration: URL: Https://www.clinicaltrials.gov. Unique identifier: NCT01176565.
KW - blood pressure
KW - cerebral hemorrhage
KW - clinical trial
KW - hematoma
KW - sex
UR - http://www.scopus.com/inward/record.url?scp=85088849154&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85088849154&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.120.029770
DO - 10.1161/STROKEAHA.120.029770
M3 - Article
C2 - 32623977
AN - SCOPUS:85088849154
SN - 0039-2499
VL - 51
SP - 2282
EP - 2286
JO - Stroke
JF - Stroke
IS - 8
ER -