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Author: search.filters.author.MUÑOZ VENTURELLI, PAULA ANDREA

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    Relative reductions in systolic blood pressure and functional outcomes in intracerebral hemorrhage: A pooled analysis of four INTERACT and ATACH-2 individual participant data
    (SAGE Publications, 2026-04-27)
    Ren, Xinwen
    ;
    Li MBiostat, Qiang
    ;
    Chen, Xiaoying
    ;
    Ouyang, Menglu
    ;
    Chen, Chen
    Background: Early intensive blood pressure (BP) lowering improves outcome after acute intracerebral hemorrhage (ICH), but the optimal degree of early systolic blood pressure (SBP) reduction remains uncertain. Aims: We aimed to identify relative SBP reduction thresholds associated with the most favorable functional outcome after ICH. Methods: We performed an individual participant data meta-analysis of five randomized trials of acute BP lowering in ICH (INTERACT1–4 and ATACH-II). The relative reduction measurements in SBP were defined as the percentage decrease (a) from baseline SBP to the lowest SBP in 1 h (primary) and (b) from baseline SBP to the achieved mean of SBP between 1 and 24 h. Associations with functional outcome, assessed as an unfavorable shift in scores on the modified Rankin scale (mRS) at the end of follow-up (90 or 180 days), were examined in multivariable ordinal logistic regression models and tested for non-linearity using restricted cubic splines. Heterogeneity of associations between the 1-hrelative SBP reduction and functional outcome by age, sex, history of hypertension, history of diabetes, baseline SBP, and hematoma volume was further explored by including each interaction term into the models. Results: Among 11,283 participants (mean age, 62.6 years; 36.0% female; mean baseline SBP, 176.9 mmHg), the association between 1-h relative SBP reduction and unfavorable functional outcome was U-shaped with an inflection nadir at around 20%. Associations differed by sex, baseline SBP, and history of diabetes (all p for interaction <0.05). A similar U-shaped association was also observed in relation to the relative SBP reduction from baseline to the achieved level in 1–24 h, with the greatest apparent benefit at approximately 30%. Conclusion: In acute ICH, a first-hour relative SBP reduction of around 20% and a 24-h reduction target of 30%, individualized to the presenting SBP, were associated with the most favorable functional outcome. Larger reductions may attenuate the benefit and should be applied cautiously, particularly in patients with very high baseline SBP.
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    Clinical characteristics and outcomes of intracerebral haemorrhage in young vs older adults: insights from the INTERACT3 trial
    (Oxford University Press (OUP), 2026-06)
    Khan, Maria
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    Ouyang, Menglu
    ;
    Wasay, Mohammad
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    Ma, L
    ;
    Hu, Xin
    Introduction ICH is a severe form of stroke with increasing global burden. Although more common in older adults, ICH in younger individuals (≤50 years) is a clinically distinct but understudied subgroup. This secondary analysis of the INTERACT3 trial compared baseline characteristics, management and outcomes between younger and older ICH patients. Patients and methods INTERACT3 was a stepped-wedge, cluster-randomised trial conducted in 122 hospitals across 10 countries (2017–2021), evaluating a bundled care intervention for acute ICH. This sub-study analysed 7031 patients and compared demographics, imaging features, in-hospital treatment and 6-month outcomes between age groups. Primary outcomes were functional status (mRS), mortality and quality of life (EQ-5D-3L). Outcomes were analysed using generalised linear-mixed models accounting for clustering by hospital (random effect) and fixed effects for time period and cluster treatment assignment, with additional adjustment for pre-specified patient-level covariates. Results Of 7031 patients, 1351 (19.2%) were aged ≤ 50 years. Younger patients were more often male (70.8% vs 62.4%, P &lt; .0001), had higher body mass index (BMI) (25.3 vs 23.8 kg/m2, P &lt; .0001) and were more likely to smoke (36.1% vs 21.4%) and consume alcohol (33.2% vs 13.3%). Despite having slightly larger haematoma volumes (18.0 vs 15.0 mL, P &lt; .0001), younger patients had significantly better outcomes, with lower 6-month mortality (9.1% vs 16.6%; adjusted OR 0.42; 95% CI, 0.33–0.54) and reduced rates of death or disability (46.5% vs 57.8%; OR 0.56; 95% CI, 0.48–0.65). A significant age-by-treatment interaction was observed (P = .0251). Conclusion Younger ICH patients demonstrated a distinct risk profile and better recovery, and benefiting more from bundled care interventions. These findings highlight the importance of early, intensive management and tailored prevention strategies targeting modifiable lifestyle risks in younger populations.
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    Implementation of stroke prevention: a review of challenges and opportunities in the Americas
    (Elsevier BV, 2026-06)
    Martins, Sheila O.
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    Ordunez, Pedro
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    Borelli, Wyllians Vendramini
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    Ovbiagele, Bruce
    ;
    Urrutia, Victor C.
      3Scopus© Citations 1
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    Epidemiology and risk factors of stroke in the Americas: a comprehensive narrative literature review
    (Elsevier BV, 2026-06)
    Silva, Gisele Sampaio
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    Diestro, Jose Danilo
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    Tarzi, Christopher
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    Kishibe, Teruko
    ;
    Bernabé-Ortiz, Antonio
      3Scopus© Citations 1
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    Impact of Ultra-Early Perioperative Antihypertensive Therapy in Acute Intracerebral Hemorrhage
    (Ovid Technologies (Wolters Kluwer Health), 2026-06)
    Tao Liu
    ;
    Linan Chen
    ;
    Leibo Liu
    ;
    Yang Liu
    ;
    Lu Ma
    <jats:sec> <jats:title>BACKGROUND:</jats:title> <jats:p>Early intensive blood pressure (BP) lowering improves outcomes in acute intracerebral hemorrhage, but its perioperative benefit among patients undergoing surgical hematoma evacuation is uncertain. We evaluated whether earlier achievement of intensive BP targets is associated with improved outcomes in this population.</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS:</jats:title> <jats:p>Post hoc secondary analysis of the INTERACT3 (the third Intensive Care Bundle With Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial) pragmatic, international, multicenter, blinded-end point, and stepped-wedge cluster-randomized trial. Among 7036 enrolled intracerebral hemorrhage patients at 121 hospitals, those who underwent surgical hematoma evacuation were included. Patients were categorized by time from hospital arrival to achieving the target systolic BP &lt;140 mm Hg: ≤2 hours versus &gt;2 hours. The primary outcome was 6-month mortality. Key secondary outcomes included death or disability (modified Rankin Scale scores 4–6), modified Rankin Scale score shift, health-related quality-of-life (EuroQol 5-Dimension 3-Level [EQ-5D-3L] domains, visual analog scale, and health utility index), and serious adverse events. Adjusted associations were estimated using Cox, logistic, ordinal logistic, and linear regression models, controlling for age, sex, treatment type, and admission Glasgow Coma Scale.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS:</jats:title> <jats:p> Of 7036 patients with acute intracerebral hemorrhage, 1506 underwent surgical hematoma evacuation (mean [SD] age, 59.7 [11.8] years; 33.9% women). Overall, there was no statistically significant difference in 6-month mortality between patients who achieved target BP within 2 hours of treatment initiation and those who achieved it after 2 hours (adjusted hazard ratio, 0.81 [95% CI, 0.63–1.04]; <jats:italic toggle="yes">P</jats:italic> =0.09). Early BP achievement was associated with a lower risk of death or disability (adjusted odds ratio [OR], 0.71 [95% CI, 0.56–0.90]; <jats:italic toggle="yes">P</jats:italic> =0.01), a favorable shift in the distribution of modified Rankin Scale scores (adjusted common OR, 0.73 [95% CI, 0.60–0.89]; <jats:italic toggle="yes">P</jats:italic> &lt;0.01), and fewer serious adverse events (adjusted OR, 0.73 [95% CI, 0.57–0.94]; <jats:italic toggle="yes">P</jats:italic> =0.02). EuroQol 5-Dimension 3-Level outcomes also favored the early group, with significant improvements in mobility (adjusted OR, 0.76 [95% CI, 0.60–0.97]; <jats:italic toggle="yes">P</jats:italic> =0.03), pain/discomfort (adjusted OR, 0.72 [95% CI, 0.54–0.95]; <jats:italic toggle="yes">P</jats:italic> =0.02), and usual activities (adjusted OR, 0.79 [95% CI, 0.62–1.00]; <jats:italic toggle="yes">P</jats:italic> =0.05), as well as higher visual analog scale (mean difference, 0.08 [95% CI, 0.002–0.17]; <jats:italic toggle="yes">P</jats:italic> =0.04) and health utility scores (mean difference, 0.05 [95% CI, 0.02–0.09]; <jats:italic toggle="yes">P</jats:italic> &lt;0.01). </jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS:</jats:title> <jats:p>In patients with intracerebral hemorrhage undergoing surgical hematoma evacuation, perioperative intensive BP reduction appears safe. Achieving systolic BP &lt;140 mm Hg within 2 hours was associated with better functional and quality-of-life outcomes, and fewer serious adverse events. These time-sensitive associations support prioritizing ultra-early perioperative BP control; confirmatory prospective analyses are warranted.</jats:p> </jats:sec> <jats:sec> <jats:title>REGISTRATION:</jats:title> <jats:p> URL: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov">https://www.clinicaltrials.gov</jats:ext-link> ; Unique identifier: NCT03209258. </jats:p> </jats:sec>
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    Predisposing Factors, Pathologies, and Precipitating Factors Causing Intracerebral Hemorrhage
    (Ovid Technologies (Wolters Kluwer Health), 2026-04)
    Alice Hosking
    ;
    Neshika Samarasekera
    ;
    Tom J. Moullaali
    ;
    William N. Whiteley
    ;
    Vega Pratiwi Putri
    <jats:sec> <jats:title/> <jats:p>Most people with spontaneous intracerebral hemorrhage (ICH) have hypertension, which is the strongest modifiable predisposing (risk) factor. However, multiple long-term medical conditions and other known predisposing factors for ICH usually coexist with hypertension, indicating that the causal pathway is multifactorial, and the term hypertensive ICH is oversimplistic. In this review, we integrate the highest quality evidence and our clinical experience in a framework to attribute multiple predisposing factors, underlying pathologies, and precipitating factors as the cause of ICH. In clinical practice, this framework supports physicians to take a holistic approach to treatment and prevention of ICH. In research, this framework shows how existing classification systems for the cause of ICH include underlying macrovascular, microvascular, and other structural pathologies but few predisposing or precipitating factors. Furthermore, this framework can inform the development of a more holistic classification system and expose knowledge gaps, including how predisposing factors lead to underlying pathologies and why only some people with these pathologies experience ICH.</jats:p> </jats:sec>
      2Scopus© Citations 1