Early Intensive BP-Lowering Beneficial in Intracerebral Hemorrhage

An individual patient-data pooled analysis of the four Intensive Blood Pressure (BP) Reduction in Acute Cerebral Haemorrhage Trials (INTERACT) supports the safety and efficacy of early intensive BP-lowering in intracerebral hemorrhage. There were 404 patients in INTERACT1, 2829 in INTERACT2, 7036 in INTERACT3, and 1043 in INTERACT4, respectively. INTERACT1–3 enrolled adults within 6 hours of symptom onset with elevated systolic BP (150 mm Hg), while INTERACT4 included suspected stroke patients within 2 hours of onset and systolic BP ≥150 mm Hg, among whom 1029 had hemorrhagic stroke. Patients were randomly assigned to receive intensive BP-lowering (target <140 mm Hg within 1 hour) or guideline-recommended treatment (target <180 mm Hg within 1 hour) using locally available medications. The primary outcome was functional recovery measured by the modified Rankin Scale (mRS), with radiological outcomes (in a CT substudy of 2921 patients) focused on hematoma volume changes. Among 11,312 patients (mean age 63 years, 35.9% female), the median time to randomization was 2.9 hours. At 1 hour, systolic BP was significantly lower in the intensive group (149.6 mm Hg) than the guideline group (158.8 mm Hg). Intensive BP-lowering significantly improved functional outcomes (OR 0.85), reduced neurological deterioration within 7 days (OR 0.76), death (OR 0.83), and serious adverse events (OR 0.84). Although no clear effect was observed on hematoma growth in the CT substudy, the benefits on function and hematoma control were strongest when treatment began within 3 hours of symptom onset. The findings emphasize the importance of rapid intervention to maximize clinical benefits. Source: https://www.thelancet.com/