Research Study Summary
Antihypertensive Treatment in Acute Cerebral Hemorrhage-II (ATACH-II)
The primary hypothesis of this large, streamlined, focused trial is that the group treated with intensive BP reduction (systolic BP [SBP] of 140 mmHg or less - hereafter referred to as the intensive treatment) using intravenous nicardipine infusion for 24 hours reduces the proportion of death and disability at 3 months by 10% or greater compared with the group treated with the standard BP reduction (SBP of 180 mmHg or less - hereafter referred to as the standard treatment) among patients with ICH treated within 3 hours of symptom onset. The underlying mechanism for this expected beneficial effect of intensive treatment is mediated through reduction of the rate and magnitude of hematoma expansion observed in approximately 38% of patients with acute ICH. The trial will recruit a maximum of 1,350 subjects with ICH who meet the eligibility criteria. The primary outcome is the proportion of death and disability at 3 months defined by modified Rankin scale (mRS) score of 4 to 6. The proposed clinical trial is the natural extension of numerous case series, a subsequent pilot trial funded by the National Institutes of Health National Institute of Health (NIH), and a preliminary randomized controlled trial in this patient group funded by the Australian National Health and Medical Research Council, that have recently confirmed the safety and tolerability of both the regimen and goals of the antihypertensive treatment in acutely hypertensive patients with ICH proposed in the present trial. The proposed trial will have important public health implications by providing necessary information regarding the efficacy and safety of antihypertensive treatment of acute hypertension observed in up to 75% of the subjects with ICH. BP treatment represents a strategy that can be made widely available without the need of specialized equipment and personnel and therefore can make a major impact upon outcome in patients with ICH. Substantial reduction in morbidity and mortality appears possible if the estimates of treatment effect sizes from our current pilot trials are accurate.
Patient Inclusion Criteria:
- Age 18 years or older and less than 90 years.
- IV nicardipine can be initiated within 3 hours of symptom onset.
- Clinical signs consistent with the diagnosis of stroke, including impairment of language, motor function, cognition, and/or gaze, vision, or neglect.
- Total GCS score (aggregate of verbal, eye, and motor response scores) of 5 or greater at time of ED arrival.
- CT scan demonstrates intraparenchymal hematoma with manual hematoma volume measurement <60 cc.
- For subjects randomized prior to infusion start: Admission SBP greater than 180 mmHg but less than 240 mmHg AND WITHOUT spontaneous SBP reduction to below 180 mmHg at the time of randomization. OR For subjects randomized after infusion start: Admission SBP greater than 180 mmHg but less than 240 mmHg AND WITHOUT SBP reduction to below 140 mmHg at the time of randomization.
- Informed consent obtained by subject, legally authorized representative, or next of kin.
Patient Exclusion Criteria:
- ICH is due to previously known neoplasms, AVM, or aneurysms.
- Intracerebral hematoma considered to be related to trauma.
- ICH located in infratentorial regions such as pons or cerebellum.
- IVH associated with intraparenchymal hemorrhage and blood completely fills one lateral ventricle or more than half of both ventricles.
- Patient to receive immediate surgical evacuation.
- Current pregnancy, or parturition within previous 30 days, or active lactation.
- Use of warfarin within the last 5 days and INR >4.
- A platelet count less than 50,000/mm3
- Known sensitivity to nicardipine.
- Pre-morbid disability requiring assistance in ambulation or activities of daily living.
- Subject's living will precludes aggressive ICU management.
- Subject is currently participating in another interventional clinical trial
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Date Last Changed:
July 19, 2013
Clinical Trial Snapshot
- Both Male and Female
- 18 to 90 Years
- Overall Status
- Facility Type
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