title: Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage.
abstract: BACKGROUND
  Whether rapid lowering of elevated blood pressure would improve the outcome in patients with intracerebral hemorrhage is not known.
  
  
  METHODS
  We randomly assigned 2839 patients who had had a spontaneous intracerebral hemorrhage within the previous 6 hours and who had elevated systolic blood pressure to receive intensive treatment to lower their blood pressure (with a target systolic level of <140 mm Hg within 1 hour) or guideline-recommended treatment (with a target systolic level of <180 mm Hg) with the use of agents of the physician's choosing. The primary outcome was death or major disability, which was defined as a score of 3 to 6 on the modified Rankin scale (in which a score of 0 indicates no symptoms, a score of 5 indicates severe disability, and a score of 6 indicates death) at 90 days. A prespecified ordinal analysis of the modified Rankin score was also performed. The rate of serious adverse events was compared between the two groups.
  
  
  RESULTS
  Among the 2794 participants for whom the primary outcome could be determined, 719 of 1382 participants (52.0%) receiving intensive treatment, as compared with 785 of 1412 (55.6%) receiving guideline-recommended treatment, had a primary outcome event (odds ratio with intensive treatment, 0.87; 95% confidence interval [CI], 0.75 to 1.01; P=0.06). The ordinal analysis showed significantly lower modified Rankin scores with intensive treatment (odds ratio for greater disability, 0.87; 95% CI, 0.77 to 1.00; P=0.04). Mortality was 11.9% in the group receiving intensive treatment and 12.0% in the group receiving guideline-recommended treatment. Nonfatal serious adverse events occurred in 23.3% and 23.6% of the patients in the two groups, respectively.
  
  
  CONCLUSIONS
  In patients with intracerebral hemorrhage, intensive lowering of blood pressure did not result in a significant reduction in the rate of the primary outcome of death or severe disability. An ordinal analysis of modified Rankin scores indicated improved functional outcomes with intensive lowering of blood pressure. (Funded by the National Health and Medical Research Council of Australia; INTERACT2 ClinicalTrials.gov number, NCT00716079.).
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, NSW, Australia. canderson@georgeinstitute.org.au
authors.forename: Craig S
authors.initials: CS
authors.lastname: Anderson
authors.forename: Emma
authors.initials: E
authors.lastname: Heeley
authors.forename: Yining
authors.initials: Y
authors.lastname: Huang
authors.forename: Jiguang
authors.initials: J
authors.lastname: Wang
authors.forename: Christian
authors.initials: C
authors.lastname: Stapf
authors.forename: Candice
authors.initials: C
authors.lastname: Delcourt
authors.forename: Richard
authors.initials: R
authors.lastname: Lindley
authors.forename: Thompson
authors.initials: T
authors.lastname: Robinson
authors.forename: Pablo
authors.initials: P
authors.lastname: Lavados
authors.forename: Bruce
authors.initials: B
authors.lastname: Neal
authors.forename: Jun
authors.initials: J
authors.lastname: Hata
authors.forename: Hisatomi
authors.initials: H
authors.lastname: Arima
authors.forename: Mark
authors.initials: M
authors.lastname: Parsons
authors.forename: Yuechun
authors.initials: Y
authors.lastname: Li
authors.forename: Jinchao
authors.initials: J
authors.lastname: Wang
authors.forename: Stephane
authors.initials: S
authors.lastname: Heritier
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.forename: R John
authors.initials: RJ
authors.lastname: Simes
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Davis
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
mesh_terms: D000208:Acute Disease; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016037:Single-Blind Method; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents