Abstract 113: Beneficial or Harmful? The Role of Intensive Anti-hypertensive Treatment in the Development of Chronic Kidney Disease

Hypertension is the leading cause of end-stage renal disease, and one of the goals of anti-hypertensive treatment is to protect the kidney. However, it is unknown how low of blood pressure as the treatment target should be so that anti-hypertensive therapy would not bring harm to patients especially for those already suffer from chronic kidney disease (CKD). Thus, we used the data set from The Systolic Blood Pressure Intervention Trial (SPRINT) to study the effect of lowering systolic blood pressure on renal disease development. The SPRINT data randomly assigned patients with a systolic blood pressure (SBP) of 130 mm Hg or higher to a SBP treatment target of less than 120 mm Hg (intensive treatment, n=4678) or a treatment target of less than 140 mm Hg (standard treatment, n=4683). We examined the effect of intensive treatment on six renal outcomes: 1) CKD composite, 2)50 percent reduction in eGFR, 3) dialysis 4) albuminuria, 5) 30 percent reduction in eGFR for patients with CKD at baseline (n=2646) and 6) albuminuria for patients without CKD at baseline (n=6715). Generalized Estimating Equation is used to account the correlation of blood pressure levels over time. At the end of year 1, the mean SBP was 121.4± 0.21 mm Hg in the intensive treatment group and 136.2± 0.21 mm Hg in the standard treatment group. The patients in intensive group were found to have a higher chance of 30% reduction of eGFR (OR=3.684, 95% CI= 2.51-5.40) than in standard treatment group. There was no difference between intensive and standard treatment groups for other 5 outcomes. In addition, 1 mm Hg elevation in SBP in patients with CDK at baseline significantly increased the chance of CKD composite (OR=1.03, 95% CI=1.01-1.04), the chance of 50 percent reduction in eGFR (OR=1.02, 95% CI=1.01-1.05), and chance of 30 percent reduction in eGFR (OR=1.02, 95% CI=1.01-1.02). Thus, SBP significantly correlated with renal outcomes in CKD patients. Our data show that five renal outcomes examined using SPRINT data set are not improved by intensive management of SBP in CKD patients, rather, patients received intensive management have a higher risk of eGFR reduction by 30%, which could be detrimental. Our study indicated that intensive SBP management should not be recommended to CKD patients.

Download Full-text

Effects of different ablation points of renal denervation on the efficacy of resistant hypertension

PeerJ ◽

10.7717/peerj.9842 ◽

2020 ◽

Vol 8 ◽

pp. e9842

Author(s):

Hua Zhang ◽

Ling-Yan Li ◽

Rong-Xue Xiao ◽

Ting-Chuan Zhang ◽

Zong-Jun Liu ◽

...

Keyword(s):

Blood Pressure ◽

Treatment Group ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Resistant Hypertension ◽

Renal Denervation ◽

Standard Treatment ◽

Intensive Treatment Group ◽

The Mean ◽

Standard Treatment Group

Objective To explore the blood pressure response to different ablation points of renal denervation (RDN) in patients with resistant hypertension Methods A total of 42 cases with resistant hypertension treated by RDN in our center from 2013 to 2015 were retrospectively analyzed. The patients were divided into two groups according to the different ablation points of RDN: the standard treatment group (spiral ablation from near to proximal, with less than 8 points per artery) and the intensive treatment group (from near to far by spiral ablation, with at least 8 points per artery), with 21 patients in each group. The ablation parameters, including points, impedance, actual wattage, and actual temperature, were recorded intraoperatively. Renal angiography was performed again after RDN. Ambulatory blood pressure (ABP) images were taken for all patients at the baseline and 6 months after operation. Results The mean 24-h blood pressure of the standard treatment group was lower than that of the baseline (24-h systolic blood pressure decreased by 7.4 ± 10.6 mmHg and 24-h diastolic blood pressure decreased by 4.6 ± 6.1 mmHg), and the mean 24-h blood pressure decreased significantly from baseline to 6 months in the intensive treatment group (24–h systolic blood pressure decreased by 27.4 ± 11.4 mmHg, P < 0.0001; 24–h diastolic blood pressure decreased by 10.9 ± 9.6 mmHg, P = 0.005). There was a positive correlation between the decrease of systolic/diastolic 24-hour mean and the number of ablation points used in the procedure. The mean value of systolic and diastolic blood pressure was positively correlated with ablation points at 24-hour (R2 = 0.777 and 0.633 respectively, P < 0.01). There were no adverse events in either group after the operation and during the follow-up. Conclusions RDN could significantly reduce BP in patients with resistant hypertension. Our study showed that the antihypertensive effect appeared to be positively correlated with the number of ablation points.

Download Full-text

Abstract WP396: Analysis of Patients With Excessively High Pre-Randomization Systolic Blood Pressure and Effect of Intensive Systolic Blood Pressure Reduction in Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) 2

Stroke ◽

10.1161/str.51.suppl_1.wp396 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Adnan I Qureshi ◽

Lydia D Foster ◽

Iryna Lobanova ◽

Wei Huang ◽

Jose I Suarez ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Treatment Effect ◽

Standard Treatment ◽

Blood Pressure Reduction ◽

Intensive Treatment ◽

Hematoma Expansion ◽

Disability Score ◽

Modifying Effect ◽

Current Guidelines

Background: Current guidelines recommend for intracerebral hemorrhage (ICH) patients with the systolic blood pressure (SBP) >220 mmHg, unlike those with initial SBP 150-220 mm, Hg, the efficacy of aggressive reduction of SBP is less well established and further studies are recommended. Methods: We analyzed data from ATACH 2 trial which randomized patients with initial SBP >180 mm Hg to intensive (goal 110-139 mmHg) and standard (goal 140-179 mmHg) SBP reduction using IV nicardipine within 4.5 hours of symptom onset. We compared the characteristics and outcomes between patients with pre- randomization SBP ≥220 mm Hg and those with initial SBP <220 mm Hg. We analyzed the modifying effect (interaction test) of pre-randomization SBP ≥220 mm Hg on treatment effect (intensive versus standard) on death or disability (score 4-6 on modified Rankin scale) at 3-months post-randomization ascertained by a blinded investigator. Results: Of 1000 randomized subjects, 48 subjects had a pre-randomization SBP ≥ 220 mm Hg (mean age 57.8 years, 65% men); 24 were assigned to intensive-treatment and standard-treatment each. The rate of death or disability at 3 months (47.9% versus 37.7%, odds ratio (OR): 1.52, 95% confidence interval (CI): 0.43 to 1.5, 0.85 to 2.72) and hematoma expansion within 24 hours (30.0% versus 21.2%, OR: 1.60; 95% CI: 0.80 to 3.20) was not different among subjects with SBP≥220 mm Hg SBP and those with SBP < 220 mm Hg. Rates of hematoma expansion (19% and 27.3%, OR: 0.63; 95% CI: 0.15 to 2.6) and neurological deterioration (8.7% versus 17.4%, OR: 0.45; 95% CI: 0.07 to 2.8) within 24 hours were not different between those randomized to intensive treatment and those to standard treatment in patients with SBP≥220 mm Hg. The interaction between initial SBP ≥220 mm Hg and treatment effect on death or disability was significant (p=0.0111). Conclusions: Patients with pre-randomization SBP ≥220 mm Hg did not have higher rates of hematoma expansion or death or disability compared to those with SBP <220 mm Hg. The interaction of pre- randomization SBP ≥220 mm Hg with the treatment effect and a non-significantly higher rate of death or disability associated with intensive treatment requires further studies.

Download Full-text

Heart Failure Events in a Clinical Trial on Arterial Hypertension: New Insights Into the SPRINT Trial

Hypertension ◽

10.1161/hypertensionaha.121.17360 ◽

2021 ◽

Vol 78 (5) ◽

pp. 1241-1247

Author(s):

Piotr Sobieraj ◽

Peter M. Nilsson ◽

Thomas Kahan

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Standard Treatment ◽

Hazard Ratio ◽

Intensive Treatment ◽

Coronary Syndrome ◽

End Point ◽

Reduced Risk

SPRINT (Systolic Blood Pressure Intervention Trial) showed that intensive lowering of systolic blood pressure to <120 mm Hg was beneficial, as compared with standard treatment in which systolic blood pressure is lowered to <140 mm Hg. The proposal that the results of SPRINT were mainly driven by the reduction of heart failure events has undermined the main conclusion of the study. Therefore, this study aimed to assess whether the intensive treatment group was also associated with a reduced risk of cardiovascular events when heart failure events were excluded from the primary composite end point. The SPRINT data were analyzed with a redefined composite end point including myocardial infarction, acute coronary syndrome other than myocardial infarction, stroke, and cardiovascular death (excluding heart failure events). The results show that intensive treatment (<120 mm Hg) is associated with a reduced risk for the redefined composite end point (hazard ratio, 0.79 [95% CI, 0.66–0.95]; P =0.012), as compared with the standard treatment (<140 mm Hg), and with results similar to the original SPRINT findings (hazard ratio, 0.75 [95% CI, 0.64–0.89]; P <0.001). Overall, the main results of SPRINT are not driven by a reduction in heart failure events. Moreover, this post hoc analysis supports the use of a more intensive treatment strategy for high-risk hypertensive patients. Graphic Abstract: An online graphic abstract is available for this article.

Download Full-text

Heart failure events in a clinical trial of arterial hypertension. The acquittal of the SPRINT trial

European Heart Journal ◽

10.1093/ehjci/ehaa946.2772 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Sobieraj ◽

T Kahan ◽

P.M Nilsson

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Systolic Blood Pressure ◽

Standard Treatment ◽

Intensive Treatment ◽

Kaplan Meier

Abstract Introduction The Systolic Blood Pressure Intervention Trial (SPRINT) was a randomized trial showing that intensive lowering of systolic blood pressure (BP), as compared to standard treatment (i.e. <120 vs <140 mm Hg) was associated with a reduced risk (HR 0.75 [95% CI 0.64–0.79], p<0.001) for the primary composite outcome (CE), defined as myocardial infarction, an acute coronary syndrome other than myocardial infarction, stroke, acute exacerbation of heart failure and cardiovascular death. primary outcome event in subjects at high cardiovascular risk. However, the primary endpoint events in the intensive treatment arm were only 76 fewer than in the standard treatment arm (243 vs 319 events), and he reduction in heart failure events was responsible for half of the effect (62 vs 100 events, i.e. 38 events fewer). Thus, several experts in hypertension argued that these results were mainly driven by a reduction of heart failure events, and questioned the main conclusion of the study. Aim To assess the effect of SPRINT intervention on a redefined CE: the primary SPRINT endpoint with HF events excluded. Material and methods We used limited SPRINT data, available from the NHLBI Biologic Specimen and Data Repository to assess the impact of BP intervention in SPRINT on a redefined CE excluding HF events. The Chi-square test, Cox proportional model and survival analysis were applied. Results Among 9361 SPRINT participants (mean age 67.9±9.5 years, 35.6% female, 20% with previous cardiovascular disease), there was 461 CE events. There were fewer CE events in the intensive treatment arm than in the standard treatment arm (204 [4.4%] vs 257 [5.5%], p=0.0117, respectively). Intensive systolic BP lowering was associated with lower risk for CE than standard treatment (HR 0.79 [95% CI 0.66–0.95], p=0.0115). Kaplan-Meier curves show that intensive treatment was associated with better outcome (Figure 1). Analyses in subgroups (age >75 vs <75 years, female vs male, black vs non-black, prior cardiovascular disease vs no cardiovascular disease, prior chronic kidney disease vs no chronic kidney disease) showed no difference in benefit of intensive treatment (p for interaction >0.05 in all subgroup). Conclusion The reduction in cardiovascular events by intensive BP lowering in SPRINT was not explained by a difference in heart failure events. This supports the concept that more intensive BP reduction may provide benefit in reducing cardiovascular event risk. Figure 1. Kaplan-Meier curves Funding Acknowledgement Type of funding source: None

Download Full-text

Effect of Intensive Blood Pressure Control on Aortic Stiffness in the SPRINT-HEART

Hypertension ◽

10.1161/hypertensionaha.120.16676 ◽

2021 ◽

Vol 77 (5) ◽

pp. 1571-1580

Author(s):

Bharathi Upadhya ◽

Nicholas M. Pajewski ◽

Michael V. Rocco ◽

W. Gregory Hundley ◽

Gerard Aurigemma ◽

...

Keyword(s):

Blood Pressure ◽

Pulse Wave Velocity ◽

Systolic Blood Pressure ◽

Wave Velocity ◽

Aortic Stiffness ◽

Standard Treatment ◽

Pulse Wave ◽

Intensive Treatment ◽

Intensive Blood Pressure

In a subgroup of 337 participants (mean age 64±9 years; 45% women) from the SPRINT (Systolic Blood Pressure Intervention Trial), where participants were randomly assigned to intensive treatment (target systolic blood pressure <120 mm Hg) versus standard treatment (<140 mm Hg), we examined the effect of intensive blood pressure lowering on indexes of aortic stiffness. Carotid-femoral pulse wave velocity, a validated global measure of aortic stiffness, was measured by echo-guided Doppler at baseline and 18-month follow-up visit. Aortic elastance, distensibility, and compliance were measured by cardiac magnetic resonance imaging. During follow-up, the intensive treatment produced a mean between-group reduction in systolic blood pressure of 12.7 mm Hg (95% CI, 11.1–14.3 mm Hg). During follow-up, intensive treatment significantly attenuated the increase in carotid-femoral pulse wave velocity compared with standard treatment (adjusted follow-up least square mean=9.0 m/s [95% CI, 8.7–9.3] versus 10.0 m/s [9.6–10.3]; P <0.001), an effect that persisted even after adjusting for mean arterial pressure. Intensive treatment also decreased the aortic elastance index (least square mean, 1.38 mm Hg/mL per m 2 [95% CI, 1.34–1.41] versus 1.48 mm Hg/mL per m 2 [95% CI, 1.44–1.51], P =0.002) compared with standard treatment. No significant between-group differences were observed for aortic distensibility and compliance. We conclude that intensive treatment significantly attenuated increases in carotid-femoral pulse wave velocity and aortic elastance index. Attenuation of increases in aortic stiffness may be one of the mechanisms contributing to the benefit of intensive blood pressure treatment observed in SPRINT. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01206062.

Download Full-text

Applicability and cost-effectiveness of the Systolic Blood Pressure Intervention Trial (SPRINT) in the Chinese population: A cost-effectiveness modeling study

PLoS Medicine ◽

10.1371/journal.pmed.1003515 ◽

2021 ◽

Vol 18 (3) ◽

pp. e1003515

Author(s):

Chao Li ◽

Kangyu Chen ◽

Victoria Cornelius ◽

Ewan Tomeny ◽

Yang Wang ◽

...

Keyword(s):

Blood Pressure ◽

Cost Effectiveness ◽

Systolic Blood Pressure ◽

Standard Treatment ◽

Cost Effective ◽

Intensive Treatment ◽

Adverse Event Rate ◽

Intervention Trial ◽

Chinese Adults ◽

Life Years

Background The Systolic Blood Pressure Intervention Trial (SPRINT) showed significant reductions in death and cardiovascular disease (CVD) risk with a systolic blood pressure (SBP) goal of <120 mm Hg compared with a SBP goal of <140 mm Hg. Our study aimed to assess the applicability of SPRINT to Chinese adults. Additionally, we sought to predict the medical and economic implications of this intensive SBP treatment among those meeting SPRINT eligibility. Methods and findings We used nationally representative baseline data from the China Health and Retirement Longitudinal Study (CHARLS) (2011–2012) to estimate the prevalence and number of Chinese adults aged 45 years and older who meet SPRINT criteria. A validated microsimulation model was employed to project costs, clinical outcomes, and quality-adjusted life-years (QALYs) among SPRINT-eligible adults, under 2 alternative treatment strategies (SBP goal of <120 mm Hg [intensive treatment] and SBP goal of <140 mm Hg [standard treatment]). Overall, 22.2% met the SPRINT criteria, representing 116.2 (95% CI 107.5 to 124.8) million people in China. Of these, 66.4%, representing 77.2 (95% CI 69.3 to 85.0) million, were not being treated for hypertension, and 22.9%, representing 26.6 (95% CI 22.4 to 30.7) million, had a SBP between 130 and 139 mm Hg, yet were not taking antihypertensive medication. We estimated that over 5 years, compared to standard treatment, intensive treatment would reduce heart failure incidence by 0.84 (95% CI 0.42 to 1.25) million cases, reduce CVD deaths by 2.03 (95% CI 1.44 to 2.63) million cases, and save 3.84 (95% CI 1.53 to 6.34) million life-years. Estimated reductions of 0.069 (95% CI −0.28, 0.42) million myocardial infarction cases and 0.36 (95% CI −0.10, 0.82) million stroke cases were not statistically significant. Furthermore, over a lifetime, moving from standard to intensive treatment increased the mean QALYs from 9.51 to 9.87 (an increment of 0.38 [95% CI 0.13 to 0.71]), at a cost of Int$10,997 per QALY gained. Of all 1-way sensitivity analyses, high antihypertensive drug cost and lower treatment efficacy for CVD death resulted in the 2 most unfavorable results (Int$25,291 and Int$18,995 per QALY were gained, respectively). Simulation results indicated that intensive treatment could be cost-effective (82.8% probability of being below the willingness-to-pay threshold of Int$16,782 [1× GDP per capita in China in 2017]), with a lower probability in people with SBP 130–139 mm Hg (72.9%) but a higher probability among females (91.2%). Main limitations include lack of specific SPRINT eligibility information in the CHARLS survey, uncertainty about the implications of different blood pressure measurement techniques, the use of several sources of data with large reliance on findings from SPPRINT, limited information about the serious adverse event rate, and lack of information and evidence for medication effectiveness on renal disease. Conclusions Although adoption of the SPRINT treatment strategy would increase the number of Chinese adults requiring SBP treatment intensification, this approach has the potential to prevent CVD events, to produce gains in life-years, and to be cost-effective under common thresholds.

Download Full-text

Orthostatic Hypertension and Intensive Blood Pressure Control; Post-Hoc Analyses of SPRINT

Hypertension ◽

10.1161/hypertensionaha.120.15887 ◽

2021 ◽

Vol 77 (1) ◽

pp. 49-58

Author(s):

Mahboob Rahman ◽

Nishigandha Pradhan ◽

Zhengyi Chen ◽

Radhika Kanthety ◽

Raymond R. Townsend ◽

...

Keyword(s):

Blood Pressure ◽

Treatment Group ◽

Standard Treatment ◽

Cardiovascular Outcomes ◽

Hazard Ratio ◽

Intensive Treatment ◽

Cardiovascular Outcome ◽

Intensive Treatment Group ◽

Orthostatic Hypertension ◽

Post Hoc

We evaluated the association between orthostatic hypertension and cardiovascular outcomes and the effect of intensive blood pressure (BP) control on cardiovascular outcomes in patients with orthostatic hypertension. Post hoc analyses of the SPRINT (Systolic Blood Pressure Intervention Trial) data were conducted; orthostatic hypertension was defined as increase in systolic BP≥20 mm Hg or increase in diastolic BP≥10 mm Hg with standing. Of 9329 participants, 1986 (21.2%) had orthostatic hypertension at baseline. Within the intensive treatment group, participants with orthostatic hypertension were at higher risk of developing the composite cardiovascular outcome (hazard ratio, 1.44 [95% CI, 1.1–1.87], P =0.007) compared with participants without orthostatic hypertension. Within the standard treatment group, there were no significant differences in cardiovascular outcome between participants with and without orthostatic hypertension. In participants with orthostatic hypertension, there was no statistically significant difference in risk of the composite cardiovascular outcome between the intensive and the standard BP treatment group (hazard ratio, 1.07 [95% CI, 0.78–1.47], P =0.68). In participants without orthostatic hypertension at baseline, the intensive treatment group was associated with a lower risk of the composite cardiovascular outcome (hazard ratio, 0.67 [95% CI, 0.56–0.79], P <0.0001). Orthostatic hypertension was associated with a higher risk of cardiovascular outcomes in the intensive and not in the standard treatment group; intensive treatment of BP did not reduce the risk of cardiovascular outcomes compared with standard treatment in patients with orthostatic hypertension. These post hoc analyses are hypothesis generating and will need to be confirmed in future studies.

Download Full-text

Outcome of Using Intravenous Immunoglobulin (IVIG) in Critically Ill COVID-19 Patients’: A ‎Retrospective, ‏Multi-Centric Cohort Study

10.21203/rs.3.rs-903345/v1 ◽

2021 ◽

Author(s):

Mohammadreza Salehi ◽

Mahdi Barkhori Mehni ◽

Mohammadmehdi Akbarian ◽

Samrand Fattah Ghazi ◽

Nasim Khajavi Rad ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Treatment Group ◽

Mortality Rate ◽

Length Of Stay ◽

Standard Treatment ◽

Ivig Treatment ◽

Icu Length Of Stay ◽

Duration Of Hospitalization ◽

Standard Treatment Group

Abstract Background: To access the effect of Intravenous immunoglobulin ‎‎(IVIG) in critically ill corona virus disease 2019 (COVID-19) patients.Method: In this retrospective matched cohort study, records of three tertiary centers with large number of COVID-19 admissions were evaluated and used. Based on treatment options, ‎patients were divided into two groups, standard COVID-19 treatment (109 patients) and IVIG treatment (74 patients) patients. Also, the effect of IVIG in different dosages was evaluated. Patients with IVIG treatment were divided into three groups of ‎low (0.25 gr/kg), medium (0.5 gr/kg), and high (1 gr/kg) dose. Data analysis was performed using independent t-test and ‎One-way analysis of variance (ANOVA) to compare the ‎outcomes between two groups, including duration of hospitalization, intensive care unit (ICU) length of stay, and mortality rate.‎Result: The duration of hospitalization in the IVIG group ‎were significantly longer than standard treatment (13.74 days vs. 11.10 days, p<0.05). There was not a significant difference between the two groups in ICU length of stay, number of intubated patients and duration of mechanical ventilation (P>0.05).‎ Also initial ‎outcomes in IVIG subgroups were compared separately with the standard ‎treatment group. The results indicated that only the duration of hospitalization ‎in the IVIG subgroup with medium dose is significantly longer than the standard ‎treatment group (P<0.01).Conclusion: Using IVIG is not beneficial for COVID-19 patients based on no remarkable differences in duration of hospitalization, ICU length of stay, duration of mechanical ventilation and even mortality rate.

Download Full-text

Drainage, irrigation and fibrinolytic therapy (DRIFT) for posthaemorrhagic ventricular dilatation: 10-year follow-up of a randomised controlled trial

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2019-318231 ◽

2020 ◽

Vol 105 (5) ◽

pp. 466-473 ◽

Cited By ~ 1

Author(s):

Karen Luyt ◽

Sally L Jary ◽

Charlotte L Lea ◽

Grace J. Young ◽

David E Odd ◽

...

Keyword(s):

Treatment Group ◽

Randomised Controlled Trial ◽

Standard Treatment ◽

Controlled Trial ◽

Fibrinolytic Therapy ◽

Ventricular Dilatation ◽

Cognitive Disability ◽

Randomised Controlled ◽

Standard Treatment Group

BackgroundProgressive ventricular dilatation after intraventricular haemorrhage (IVH) in preterm infants has a very high risk of severe disability and death. Drainage, irrigation and fibrinolytic therapy (DRIFT), in a randomised controlled trial (RCT), reduced severe cognitive impairment at 2 years.ObjectiveTo assess if the cognitive advantage of DRIFT seen at 2 years persisted until school age.ParticipantsThe RCT conducted in four centres recruited 77 preterm infants with IVH and progressive ventricular enlargement over specified measurements. Follow-up was at 10 years of age.InterventionIntraventricular injection of a fibrinolytic followed by continuous lavage, until the drainage was clear, and standard care consisting of control of expansion by lumbar punctures and if expansion persisted via a ventricular access device.Primary outcomeCognitive quotient (CQ), derived from the British Ability Scales and Bayley III Scales, and survival without severe cognitive disability.ResultsOf the 77 children randomised, 12 died, 2 could not be traced, 10 did not respond and 1 declined at 10-year follow-up. 28 in the DRIFT group and 24 in the standard treatment group were assessed by examiners blinded to the intervention. The mean CQ score was 69.3 (SD=30.1) in the DRIFT group and 53.7 (SD=35.7) in the standard treatment group (unadjusted p=0.1; adjusted p=0.01, after adjustment for the prespecified variables sex, birth weight and IVH grade). Survival without severe cognitive disability was 66% in the DRIFT group and 35% in the standard treatment group (unadjusted p=0.019; adjusted p=0.003).ConclusionDRIFT is the first intervention for posthaemorrhagic ventricular dilatation to objectively demonstrate sustained cognitive improvement.Trial registration numberISRCTN80286058.

Download Full-text