Sex Differences in Blood Pressure-Lowering Therapy and Outcomes Following Intracerebral Hemorrhage: Results from ATACH-2

Mayumi Fukuda-Doi, Haruko Yamamoto, Masatoshi Koga, Yuko Y. Palesch, Valerie L. Durkalski-Mauldin, Adnan I. Qureshi, Sohei Yoshimura, Shuhei Okazaki, Kaori Miwa, Yasushi Okada, Toshihiro Ueda, Satoshi Okuda, Jin Nakahara, Norihiro Suzuki, Kazunori Toyoda

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


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:// Unique identifier: NCT01176565.

Original languageEnglish
Pages (from-to)2282-2286
Number of pages5
Issue number8
Publication statusPublished - 2020 Aug 1


  • blood pressure
  • cerebral hemorrhage
  • clinical trial
  • hematoma
  • sex

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing


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