Supplemental tables: Impact of renal impairment on intensive blood pressure-lowering therapy and outcomes in intracerebral hemorrhage: results from ATACH-2

Background and Objectives: The clinical impact of renal impairment on
intracerebral hemorrhage (ICH) is unknown. This study sought to
exploratory assess whether the estimated glomerular filtration rate (eGFR)
affects clinical outcomes or modifies the efficacy of intensive systolic
blood pressure (BP) control (target, 110–139 mmHg) against the standard
(target, 140–179 mmHg) among patients with ICH. Methods: We conducted
post-hoc analyses of ATACH-2, a randomized, two-group, open-label trial.
The baseline eGFR of each eligible patient was calculated using the
Chronic Kidney Disease Epidemiology Collaboration equation. The outcome of
interest was death or disability at 90 days. Multivariate logistic
regression models were used for analysis. Results: Among the 1000 patients
randomized, 974 were analyzed. The median baseline eGFR was 88
(interquartile range: 68, 99) ml/min/1.73 m2; 451 (46.3%), 363 (37.3%) and
160 (16.4%) patients had baseline eGFR values of ≥90, 60–89, and
<60 ml/min/1.73 m2, respectively. Compared with normal eGFR (≥90
ml/min/1.73 m2), higher odds of death or disability were noted among those
with eGFR values of <60 ml/min/1.73 m2 (adjusted odds ratio (OR)
2.02, 95% confidence interval (CI) 1.25–3.26) but not among those with
eGFR values of 60–89 ml/min/1.73 m2 (OR 1.01, 95% CI 0.70–1.46). The odds
of death or disability were significantly higher in the intensive arm
among patients with decreased eGFR; the ORs were 0.89 (95% CI 0.55–1.44),
1.13 (0.68–1.89), and 3.60 (1.47–8.80) in patients with eGFR values of
≥90, 60–89, and <60 ml/min/1.73 m2, respectively (p for interaction
= 0.02). Discussion: Decreased eGFR is associated with unfavorable
outcomes following ICH. The statistically significant interaction between
the eGFR group and treatment assignment raised safety concerns for the
intensive BP-lowering therapy among patients with renal impairment. Trial
Registration Information: Clinicaltrials.gov (NCT01176565), first
submitted on August 6, 2010. The first patient enrolled on May 2011.
Classification of Evidence: This study provides Class II evidence that in
spontaneous ICH, decreased eGFR identifies patients at risk of death or
disability following intensive blood pressure control.