Effects of early intensive blood pressure-lowering treatment on the growth of hematoma and perihematomal edema in acute intracerebral hemorrhage: the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT).
OBJECTIVE
The Intensive Blood Pressure Reduction In Acute Cerebral Haemorrhage Trial (INTERACT) study suggests that early intensive blood pressure (BP) lowering can attenuate hematoma growth at 24 hours after intracerebral hemorrhage. The present analyses aimed to determine the effects of treatment on hematoma and perihematomal edema over 72 hours.


METHODS
INTERACT included 404 patients with CT-confirmed intracerebral hemorrhage, elevated systolic BP (150 to 220 mm Hg), and capacity to start BP-lowering treatment within 6 hours of intracerebral hemorrhage. Patients were randomly assigned to an intensive (target systolic BP 140 mmHg) or standard guideline-based management of BP (target systolic BP 180 mm Hg) using routine intravenous agents. Baseline and repeat CTs (24 and 72 hours) were performed using standardized techniques with digital images analyzed centrally. Outcomes were increases in hematoma and perihematomal edema volumes over 72 hours.


RESULTS
Overall, 296 patients had all 3 CT scans available for the hematoma and 270 for the edema analyses. Mean systolic BP was 11.7 mm Hg lower in the intensive group than in the guideline group during 1 to 24 hours. Adjusted mean absolute increases in hematoma volumes (mL) at 24 and 72 hours were 2.40 and 0.15 in the guideline group compared with -0.74 and -2.31 in the intensive group, respectively, an overall difference of 2.80 (95% CI, 1.04 to 4.56; P=0.002). Adjusted mean absolute increases in edema volumes (mL) at 24 and 72 hours were 6.27 and 10.02 in the guideline group compared with 4.19 and 7.34 in the intensive group, respectively, for an overall difference of 2.38 (95% CI, -0.45 to 5.22; P=0.10).


CONCLUSIONS
Early intensive BP-lowering treatment attenuated hematoma growth over 72 hours in intracerebral hemorrhage. There were no appreciable effects on perihematomal edema.
Anderson
Craig S
CS
The George Institute for International Health, Royal Prince Alfred Hospital and the University of Sydney, Sydney, Australia. canderson@george.org.au
Huang
Yining
Y
Arima
Hisatomi
H
Heeley
Emma
E
Skulina
Christian
C
Parsons
Mark W
MW
Peng
Bin
B
Li
Qiang
Q
Su
Steve
S
Tao
Qing Ling
QL
Li
Yue Chun
YC
Jiang
Jian Dong
JD
Tai
Li Wen
LW
Zhang
Jin Li
JL
Xu
En
E
Cheng
Yan
Y
Morgenstern
Lewis B
LB
Chalmers
John
J
Wang
Ji Guang
JG
D000208:Acute Disease / Q000628:therapy; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001315:Australia; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D001929:Brain Edema / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D002681:China; D018450:Disease Progression; D004334:Drug Administration Schedule; D042241:Early Diagnosis; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D020299:Intracranial Hemorrhage, Hypertensive / Q000150:complications / Q000188:drug therapy* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D056910:Republic of Korea; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000959:Antihypertensive Agents