Abstract
Background: The main analysis of the ATACH-2 (Antihypertensive Treatment in Intracerebral Hemorrhage-2) trial suggested no benefit from intensive blood pressure lowering (BPL) treatment after intracerebral hemorrhage (ICH). However, whether outcome and response to treatment differs according to race was not sufficiently studied. Methods: This is a post-hoc analysis of the ATACH-2 trial. The primary outcome was death or disability (90-day modified Rankin Scale [mRS] 4-6). Patients were divided according to race/ethnicity. Logistic regression was fit to assess the association between race and the primary outcome. In addition, we assessed the interaction between intensive BPL treatment and race. Results: A total of 939 patients (White=206, Asian=549, Black=111, Hispanic=73) were included. Death and disability occurred more frequently in White patients than other races (Figure). However, after adjusting for patient age, sex, baseline Glasgow Coma Scale, intracranial hemorrhage volume in mL, presence of intraventricular hemorrhage, deep vs. lobar, left vs. right hemisphere, intubation and ATACH treatment arm, Black patients had higher odds of the primary outcome (OR=1.98, P=0.02) compared to White patients. In contrast, Asian and Hispanic patients had non-statistically significant lower odds of the primary outcome (OR=0.68, P=0.09; OR= 0.97; P=0.95, respectively) compared to White patients. We did not observe treatment-by-race interaction. the p values for the interaction of intensive BPL treatment vs. standard BPL were 0.508 in Blacks, 0.336 in Hispanics and 0.190 in Asians, with Whites as the reference group. Conclusion: Black patients had higher odds of death or disability after non-traumatic supratentorial intracerebral hemorrhage compared to White patients.
Published Version
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