title: Optimal achieved blood pressure in acute intracerebral hemorrhage: INTERACT2.
abstract: OBJECTIVE
  To investigate the effects of intensive blood pressure (BP) lowering according to baseline BP levels and optimal achieved BP levels in patients with acute intracerebral hemorrhage (ICH).
  
  
  METHODS
  INTERACT2 was an open, blinded endpoint, randomized controlled trial in 2,839 patients with ICH within 6 hours of onset and elevated systolic BP (SBP) (150-220 mm Hg) who were allocated to receive intensive (target SBP <140 mm Hg within 1 hour, with lower limit of 130 mm Hg for treatment cessation) or guideline-recommended (target SBP <180 mm Hg) BP-lowering treatment. Outcome was physical function across all 7 levels of the modified Rankin Scale at 90 days.
  
  
  RESULTS
  Analysis of the randomized comparisons showed that intensive BP lowering produced comparable benefits on physical function at 90 days in 5 subgroups defined by baseline SBP of <160, 160-169, 170-179, 180-189, and ≥190 mm Hg (p homogeneity = 0.790). Analyses of achieved BP showed linear increases in the risk of physical dysfunction for achieved SBP above 130 mm Hg for both hyperacute (1-24 hours) and acute (2-7 days) phases while modest increases were also observed for achieved SBP below 130 mm Hg.
  
  
  CONCLUSIONS
  Intensive BP lowering appears beneficial across a wide range of baseline SBP levels, and target SBP level of 130-139 mm Hg is likely to provide maximum benefit in acute ICH.
  
  
  METHODS
  This study provides Class I evidence that the effect of intensive BP lowering on physical function is not influenced by baseline BP.
authors.affiliation: From The George Institute for Global Health (H.A., E.H., C.D., Y.H., X.W., M.W., J.C., C.S.A.), University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease (T.R.), University of Leicester, UK; Department of Neurology (C.S.), APHP, Hôpital Lariboisière and DHU NeuroVasc Paris, Sorbonne, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Department of Neurology (M.P.), John Hunter Hospital, University of Newcastle, Australia; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.M.L.), Universidad de Chile, Santiago; Department of Neurology (Y.H.), Peking University First Hospital, Beijing; and The Shanghai Institute of Hypertension (J.W.), Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Hisatomi
authors.initials: H
authors.lastname: Arima
authors.affiliation: From The George Institute for Global Health (H.A., E.H., C.D., Y.H., X.W., M.W., J.C., C.S.A.), University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease (T.R.), University of Leicester, UK; Department of Neurology (C.S.), APHP, Hôpital Lariboisière and DHU NeuroVasc Paris, Sorbonne, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Department of Neurology (M.P.), John Hunter Hospital, University of Newcastle, Australia; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.M.L.), Universidad de Chile, Santiago; Department of Neurology (Y.H.), Peking University First Hospital, Beijing; and The Shanghai Institute of Hypertension (J.W.), Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Emma
authors.initials: E
authors.lastname: Heeley
authors.affiliation: From The George Institute for Global Health (H.A., E.H., C.D., Y.H., X.W., M.W., J.C., C.S.A.), University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease (T.R.), University of Leicester, UK; Department of Neurology (C.S.), APHP, Hôpital Lariboisière and DHU NeuroVasc Paris, Sorbonne, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Department of Neurology (M.P.), John Hunter Hospital, University of Newcastle, Australia; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.M.L.), Universidad de Chile, Santiago; Department of Neurology (Y.H.), Peking University First Hospital, Beijing; and The Shanghai Institute of Hypertension (J.W.), Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Candice
authors.initials: C
authors.lastname: Delcourt
authors.affiliation: From The George Institute for Global Health (H.A., E.H., C.D., Y.H., X.W., M.W., J.C., C.S.A.), University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease (T.R.), University of Leicester, UK; Department of Neurology (C.S.), APHP, Hôpital Lariboisière and DHU NeuroVasc Paris, Sorbonne, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Department of Neurology (M.P.), John Hunter Hospital, University of Newcastle, Australia; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.M.L.), Universidad de Chile, Santiago; Department of Neurology (Y.H.), Peking University First Hospital, Beijing; and The Shanghai Institute of Hypertension (J.W.), Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Hirakawa
authors.affiliation: From The George Institute for Global Health (H.A., E.H., C.D., Y.H., X.W., M.W., J.C., C.S.A.), University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease (T.R.), University of Leicester, UK; Department of Neurology (C.S.), APHP, Hôpital Lariboisière and DHU NeuroVasc Paris, Sorbonne, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Department of Neurology (M.P.), John Hunter Hospital, University of Newcastle, Australia; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.M.L.), Universidad de Chile, Santiago; Department of Neurology (Y.H.), Peking University First Hospital, Beijing; and The Shanghai Institute of Hypertension (J.W.), Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Wang
authors.affiliation: From The George Institute for Global Health (H.A., E.H., C.D., Y.H., X.W., M.W., J.C., C.S.A.), University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease (T.R.), University of Leicester, UK; Department of Neurology (C.S.), APHP, Hôpital Lariboisière and DHU NeuroVasc Paris, Sorbonne, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Department of Neurology (M.P.), John Hunter Hospital, University of Newcastle, Australia; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.M.L.), Universidad de Chile, Santiago; Department of Neurology (Y.H.), Peking University First Hospital, Beijing; and The Shanghai Institute of Hypertension (J.W.), Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.affiliation: From The George Institute for Global Health (H.A., E.H., C.D., Y.H., X.W., M.W., J.C., C.S.A.), University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease (T.R.), University of Leicester, UK; Department of Neurology (C.S.), APHP, Hôpital Lariboisière and DHU NeuroVasc Paris, Sorbonne, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Department of Neurology (M.P.), John Hunter Hospital, University of Newcastle, Australia; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.M.L.), Universidad de Chile, Santiago; Department of Neurology (Y.H.), Peking University First Hospital, Beijing; and The Shanghai Institute of Hypertension (J.W.), Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Thompson
authors.initials: T
authors.lastname: Robinson
authors.affiliation: From The George Institute for Global Health (H.A., E.H., C.D., Y.H., X.W., M.W., J.C., C.S.A.), University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease (T.R.), University of Leicester, UK; Department of Neurology (C.S.), APHP, Hôpital Lariboisière and DHU NeuroVasc Paris, Sorbonne, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Department of Neurology (M.P.), John Hunter Hospital, University of Newcastle, Australia; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.M.L.), Universidad de Chile, Santiago; Department of Neurology (Y.H.), Peking University First Hospital, Beijing; and The Shanghai Institute of Hypertension (J.W.), Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Christian
authors.initials: C
authors.lastname: Stapf
authors.affiliation: From The George Institute for Global Health (H.A., E.H., C.D., Y.H., X.W., M.W., J.C., C.S.A.), University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease (T.R.), University of Leicester, UK; Department of Neurology (C.S.), APHP, Hôpital Lariboisière and DHU NeuroVasc Paris, Sorbonne, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Department of Neurology (M.P.), John Hunter Hospital, University of Newcastle, Australia; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.M.L.), Universidad de Chile, Santiago; Department of Neurology (Y.H.), Peking University First Hospital, Beijing; and The Shanghai Institute of Hypertension (J.W.), Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Mark
authors.initials: M
authors.lastname: Parsons
authors.affiliation: From The George Institute for Global Health (H.A., E.H., C.D., Y.H., X.W., M.W., J.C., C.S.A.), University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease (T.R.), University of Leicester, UK; Department of Neurology (C.S.), APHP, Hôpital Lariboisière and DHU NeuroVasc Paris, Sorbonne, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Department of Neurology (M.P.), John Hunter Hospital, University of Newcastle, Australia; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.M.L.), Universidad de Chile, Santiago; Department of Neurology (Y.H.), Peking University First Hospital, Beijing; and The Shanghai Institute of Hypertension (J.W.), Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Lavados
authors.affiliation: From The George Institute for Global Health (H.A., E.H., C.D., Y.H., X.W., M.W., J.C., C.S.A.), University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease (T.R.), University of Leicester, UK; Department of Neurology (C.S.), APHP, Hôpital Lariboisière and DHU NeuroVasc Paris, Sorbonne, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Department of Neurology (M.P.), John Hunter Hospital, University of Newcastle, Australia; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.M.L.), Universidad de Chile, Santiago; Department of Neurology (Y.H.), Peking University First Hospital, Beijing; and The Shanghai Institute of Hypertension (J.W.), Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Yining
authors.initials: Y
authors.lastname: Huang
authors.affiliation: From The George Institute for Global Health (H.A., E.H., C.D., Y.H., X.W., M.W., J.C., C.S.A.), University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease (T.R.), University of Leicester, UK; Department of Neurology (C.S.), APHP, Hôpital Lariboisière and DHU NeuroVasc Paris, Sorbonne, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Department of Neurology (M.P.), John Hunter Hospital, University of Newcastle, Australia; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.M.L.), Universidad de Chile, Santiago; Department of Neurology (Y.H.), Peking University First Hospital, Beijing; and The Shanghai Institute of Hypertension (J.W.), Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Jiguang
authors.initials: J
authors.lastname: Wang
authors.affiliation: From The George Institute for Global Health (H.A., E.H., C.D., Y.H., X.W., M.W., J.C., C.S.A.), University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease (T.R.), University of Leicester, UK; Department of Neurology (C.S.), APHP, Hôpital Lariboisière and DHU NeuroVasc Paris, Sorbonne, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Department of Neurology (M.P.), John Hunter Hospital, University of Newcastle, Australia; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.M.L.), Universidad de Chile, Santiago; Department of Neurology (Y.H.), Peking University First Hospital, Beijing; and The Shanghai Institute of Hypertension (J.W.), Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.affiliation: From The George Institute for Global Health (H.A., E.H., C.D., Y.H., X.W., M.W., J.C., C.S.A.), University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease (T.R.), University of Leicester, UK; Department of Neurology (C.S.), APHP, Hôpital Lariboisière and DHU NeuroVasc Paris, Sorbonne, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Department of Neurology (M.P.), John Hunter Hospital, University of Newcastle, Australia; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.M.L.), Universidad de Chile, Santiago; Department of Neurology (Y.H.), Peking University First Hospital, Beijing; and The Shanghai Institute of Hypertension (J.W.), Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China. canderson@georgeinstitute.org.au.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Anderson
mesh_terms: D000208:Acute Disease; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000379:methods; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D038622:Internationality; D008297:Male; D008875:Middle Aged; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents