The speed of ultraearly hematoma growth in acute intracerebral hemorrhage.
OBJECTIVE
The prognostic importance of the speed of early hematoma growth in acute intracerebral hemorrhage (ICH) has not been well established. We aimed to determine the association between the rate of increase in hematoma volume and major clinical outcomes in the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) studies. The effects of early intensive blood pressure (BP) lowering according to the speed of hematoma growth were also investigated.


METHODS
Pooled analyses of the INTERACT1 (n = 404) and INTERACT2 (n = 2,839) studies-randomized controlled trials of patients with spontaneous ICH with elevated systolic BP, randomly assigned to intensive (target systolic BP <140 mm Hg) or guideline-based (<180 mm Hg) BP management. The speed of ultraearly hematoma growth (UHG) was defined as hematoma volume (mL)/onset-to-CT time (hours). Primary outcome was death or major disability (modified Rankin Scale score of 3-6) at 90 days.


RESULTS
Among a total of 2,909 patients (90%) with information on UHG and outcome, median speed of UHG was 6.2 mL/h. There was a linear association between UHG and outcome: multivariable-adjusted odd ratios 1.90 (95% confidence interval 1.50-2.39) for 5-10 mL/h and 2.96 (2.36-3.71) for >10 mL/h vs the <5 mL/h group. There were no clear differences in the effects of intensive BP lowering according to 3 speeds of UHG on outcome (p = 0.75 for homogeneity).


CONCLUSIONS
The speed of UHG in patients with ICH was continuously associated with increased risks of death or major disability, and from lower levels than previously reported (≥5 mL/h). The benefits of intensive BP lowering appear to be independent of the speed of bleeding.
From The George Institute for Global Health (S.S., H.A., Y.H., E.H., C.D., R.I.L., J.C., C.S.A.), the University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Neurology (R.B.), Innsbruck Medical University, Austria; Department of Neurology (Y.L., J.Z.), Baotou Central Hospital, China; Center for Stroke Research Berlin (E.J.), Charité-University Medicine Berlin, Germany; The Shanghai Institute of Hypertension (J.W.), Ruijin Hospital, Shanghai Jiaotong University, China; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; and Department of Cardiovascular Sciences (T.R.), Leicester Royal Infirmary, University of Leicester, UK.
Shoichiro
S
Sato
From The George Institute for Global Health (S.S., H.A., Y.H., E.H., C.D., R.I.L., J.C., C.S.A.), the University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Neurology (R.B.), Innsbruck Medical University, Austria; Department of Neurology (Y.L., J.Z.), Baotou Central Hospital, China; Center for Stroke Research Berlin (E.J.), Charité-University Medicine Berlin, Germany; The Shanghai Institute of Hypertension (J.W.), Ruijin Hospital, Shanghai Jiaotong University, China; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; and Department of Cardiovascular Sciences (T.R.), Leicester Royal Infirmary, University of Leicester, UK.
Hisatomi
H
Arima
From The George Institute for Global Health (S.S., H.A., Y.H., E.H., C.D., R.I.L., J.C., C.S.A.), the University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Neurology (R.B.), Innsbruck Medical University, Austria; Department of Neurology (Y.L., J.Z.), Baotou Central Hospital, China; Center for Stroke Research Berlin (E.J.), Charité-University Medicine Berlin, Germany; The Shanghai Institute of Hypertension (J.W.), Ruijin Hospital, Shanghai Jiaotong University, China; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; and Department of Cardiovascular Sciences (T.R.), Leicester Royal Infirmary, University of Leicester, UK.
Yoichiro
Y
Hirakawa
From The George Institute for Global Health (S.S., H.A., Y.H., E.H., C.D., R.I.L., J.C., C.S.A.), the University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Neurology (R.B.), Innsbruck Medical University, Austria; Department of Neurology (Y.L., J.Z.), Baotou Central Hospital, China; Center for Stroke Research Berlin (E.J.), Charité-University Medicine Berlin, Germany; The Shanghai Institute of Hypertension (J.W.), Ruijin Hospital, Shanghai Jiaotong University, China; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; and Department of Cardiovascular Sciences (T.R.), Leicester Royal Infirmary, University of Leicester, UK.
Emma
E
Heeley
From The George Institute for Global Health (S.S., H.A., Y.H., E.H., C.D., R.I.L., J.C., C.S.A.), the University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Neurology (R.B.), Innsbruck Medical University, Austria; Department of Neurology (Y.L., J.Z.), Baotou Central Hospital, China; Center for Stroke Research Berlin (E.J.), Charité-University Medicine Berlin, Germany; The Shanghai Institute of Hypertension (J.W.), Ruijin Hospital, Shanghai Jiaotong University, China; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; and Department of Cardiovascular Sciences (T.R.), Leicester Royal Infirmary, University of Leicester, UK.
Candice
C
Delcourt
From The George Institute for Global Health (S.S., H.A., Y.H., E.H., C.D., R.I.L., J.C., C.S.A.), the University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Neurology (R.B.), Innsbruck Medical University, Austria; Department of Neurology (Y.L., J.Z.), Baotou Central Hospital, China; Center for Stroke Research Berlin (E.J.), Charité-University Medicine Berlin, Germany; The Shanghai Institute of Hypertension (J.W.), Ruijin Hospital, Shanghai Jiaotong University, China; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; and Department of Cardiovascular Sciences (T.R.), Leicester Royal Infirmary, University of Leicester, UK.
Ronny
R
Beer
From The George Institute for Global Health (S.S., H.A., Y.H., E.H., C.D., R.I.L., J.C., C.S.A.), the University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Neurology (R.B.), Innsbruck Medical University, Austria; Department of Neurology (Y.L., J.Z.), Baotou Central Hospital, China; Center for Stroke Research Berlin (E.J.), Charité-University Medicine Berlin, Germany; The Shanghai Institute of Hypertension (J.W.), Ruijin Hospital, Shanghai Jiaotong University, China; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; and Department of Cardiovascular Sciences (T.R.), Leicester Royal Infirmary, University of Leicester, UK.
Yuechun
Y
Li
From The George Institute for Global Health (S.S., H.A., Y.H., E.H., C.D., R.I.L., J.C., C.S.A.), the University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Neurology (R.B.), Innsbruck Medical University, Austria; Department of Neurology (Y.L., J.Z.), Baotou Central Hospital, China; Center for Stroke Research Berlin (E.J.), Charité-University Medicine Berlin, Germany; The Shanghai Institute of Hypertension (J.W.), Ruijin Hospital, Shanghai Jiaotong University, China; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; and Department of Cardiovascular Sciences (T.R.), Leicester Royal Infirmary, University of Leicester, UK.
Jingfen
J
Zhang
From The George Institute for Global Health (S.S., H.A., Y.H., E.H., C.D., R.I.L., J.C., C.S.A.), the University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Neurology (R.B.), Innsbruck Medical University, Austria; Department of Neurology (Y.L., J.Z.), Baotou Central Hospital, China; Center for Stroke Research Berlin (E.J.), Charité-University Medicine Berlin, Germany; The Shanghai Institute of Hypertension (J.W.), Ruijin Hospital, Shanghai Jiaotong University, China; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; and Department of Cardiovascular Sciences (T.R.), Leicester Royal Infirmary, University of Leicester, UK.
Eric
E
Jüettler
From The George Institute for Global Health (S.S., H.A., Y.H., E.H., C.D., R.I.L., J.C., C.S.A.), the University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Neurology (R.B.), Innsbruck Medical University, Austria; Department of Neurology (Y.L., J.Z.), Baotou Central Hospital, China; Center for Stroke Research Berlin (E.J.), Charité-University Medicine Berlin, Germany; The Shanghai Institute of Hypertension (J.W.), Ruijin Hospital, Shanghai Jiaotong University, China; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; and Department of Cardiovascular Sciences (T.R.), Leicester Royal Infirmary, University of Leicester, UK.
Jiguang
J
Wang
From The George Institute for Global Health (S.S., H.A., Y.H., E.H., C.D., R.I.L., J.C., C.S.A.), the University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Neurology (R.B.), Innsbruck Medical University, Austria; Department of Neurology (Y.L., J.Z.), Baotou Central Hospital, China; Center for Stroke Research Berlin (E.J.), Charité-University Medicine Berlin, Germany; The Shanghai Institute of Hypertension (J.W.), Ruijin Hospital, Shanghai Jiaotong University, China; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; and Department of Cardiovascular Sciences (T.R.), Leicester Royal Infirmary, University of Leicester, UK.
Pablo M
PM
Lavados
From The George Institute for Global Health (S.S., H.A., Y.H., E.H., C.D., R.I.L., J.C., C.S.A.), the University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Neurology (R.B.), Innsbruck Medical University, Austria; Department of Neurology (Y.L., J.Z.), Baotou Central Hospital, China; Center for Stroke Research Berlin (E.J.), Charité-University Medicine Berlin, Germany; The Shanghai Institute of Hypertension (J.W.), Ruijin Hospital, Shanghai Jiaotong University, China; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; and Department of Cardiovascular Sciences (T.R.), Leicester Royal Infirmary, University of Leicester, UK.
Thompson
T
Robinson
From The George Institute for Global Health (S.S., H.A., Y.H., E.H., C.D., R.I.L., J.C., C.S.A.), the University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Neurology (R.B.), Innsbruck Medical University, Austria; Department of Neurology (Y.L., J.Z.), Baotou Central Hospital, China; Center for Stroke Research Berlin (E.J.), Charité-University Medicine Berlin, Germany; The Shanghai Institute of Hypertension (J.W.), Ruijin Hospital, Shanghai Jiaotong University, China; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; and Department of Cardiovascular Sciences (T.R.), Leicester Royal Infirmary, University of Leicester, UK.
Richard I
RI
Lindley
From The George Institute for Global Health (S.S., H.A., Y.H., E.H., C.D., R.I.L., J.C., C.S.A.), the University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Neurology (R.B.), Innsbruck Medical University, Austria; Department of Neurology (Y.L., J.Z.), Baotou Central Hospital, China; Center for Stroke Research Berlin (E.J.), Charité-University Medicine Berlin, Germany; The Shanghai Institute of Hypertension (J.W.), Ruijin Hospital, Shanghai Jiaotong University, China; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; and Department of Cardiovascular Sciences (T.R.), Leicester Royal Infirmary, University of Leicester, UK.
John
J
Chalmers
From The George Institute for Global Health (S.S., H.A., Y.H., E.H., C.D., R.I.L., J.C., C.S.A.), the University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Neurology (R.B.), Innsbruck Medical University, Austria; Department of Neurology (Y.L., J.Z.), Baotou Central Hospital, China; Center for Stroke Research Berlin (E.J.), Charité-University Medicine Berlin, Germany; The Shanghai Institute of Hypertension (J.W.), Ruijin Hospital, Shanghai Jiaotong University, China; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; and Department of Cardiovascular Sciences (T.R.), Leicester Royal Infirmary, University of Leicester, UK. canderson@georgeinstitute.org.au.
Craig S
CS
Anderson
D000208:Acute Disease; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D006406:Hematoma / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D013997:Time Factors; D016896:Treatment Outcome