title: Magnitude of blood pressure reduction and clinical outcomes in acute intracerebral hemorrhage: intensive blood pressure reduction in acute cerebral hemorrhage trial study.
abstract: Evidence supports early intensive blood pressure (BP) lowering in acute intracerebral hemorrhage, but uncertainty persists over whether potential benefits and harms vary according to the magnitude of BP reduction. We aimed to determine whether larger systolic BP (SBP) reductions were associated with better outcomes in participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). INTERACT2 was an international, open, blinded end point, randomized controlled trial of patients with spontaneous intracerebral hemorrhage (<6 hours) and elevated SBP (150-220 mm Hg) assigned to intensive (target SBP <140 mm Hg) or guideline-recommended (SBP <180 mm Hg) treatment. Associations of BP reduction (baseline minus average of achieved SBP) during 3 time periods post randomization (15-60 minutes, 1-24 hours, and 2-7 days) on poor outcome (death or major disability) at 90 days were analyzed in multivariable logistic regression models with odds ratios and 95% confidence intervals. Larger SBP reductions within the first hour after randomization were associated with lower risks of poor outcome: compared with minimal reduction (<10 mm Hg), odds ratios were 0.80 (95% confidence interval, 0.63-1.02) for moderate (10-20 mm Hg) and 0.65 (0.52-0.82) for large (≥20 mm Hg) reductions (P trend <0.01). Similar associations were also observed for SBP reductions during 1 to 24 hours (P<0.01) and 2 to 7 days (P 0.02). No heterogeneity in associations for patients above or below baseline SBP 180 mm Hg was reported (P>0.30). Optimal recovery from intracerebral hemorrhage was observed in hypertensive patients who achieved the greatest SBP reductions (≥20 mm Hg) in the first hour and maintained for 7 days.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00716079.
authors: From the George Institute for Global Health, Neurological and Mental Health Division, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., E.H., C.D., M.W., J.C., C.S.A.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.W.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); and Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.).
authors: Xia
authors: X
authors: Wang
authors: From the George Institute for Global Health, Neurological and Mental Health Division, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., E.H., C.D., M.W., J.C., C.S.A.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.W.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); and Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.).
authors: Hisatomi
authors: H
authors: Arima
authors: From the George Institute for Global Health, Neurological and Mental Health Division, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., E.H., C.D., M.W., J.C., C.S.A.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.W.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); and Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.).
authors: Emma
authors: E
authors: Heeley
authors: From the George Institute for Global Health, Neurological and Mental Health Division, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., E.H., C.D., M.W., J.C., C.S.A.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.W.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); and Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.).
authors: Candice
authors: C
authors: Delcourt
authors: From the George Institute for Global Health, Neurological and Mental Health Division, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., E.H., C.D., M.W., J.C., C.S.A.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.W.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); and Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.).
authors: Yining
authors: Y
authors: Huang
authors: From the George Institute for Global Health, Neurological and Mental Health Division, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., E.H., C.D., M.W., J.C., C.S.A.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.W.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); and Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.).
authors: Jiguang
authors: J
authors: Wang
authors: From the George Institute for Global Health, Neurological and Mental Health Division, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., E.H., C.D., M.W., J.C., C.S.A.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.W.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); and Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.).
authors: Christian
authors: C
authors: Stapf
authors: From the George Institute for Global Health, Neurological and Mental Health Division, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., E.H., C.D., M.W., J.C., C.S.A.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.W.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); and Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.).
authors: Thompson
authors: T
authors: Robinson
authors: From the George Institute for Global Health, Neurological and Mental Health Division, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., E.H., C.D., M.W., J.C., C.S.A.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.W.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); and Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.).
authors: Mark
authors: M
authors: Woodward
authors: From the George Institute for Global Health, Neurological and Mental Health Division, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., E.H., C.D., M.W., J.C., C.S.A.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.W.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); and Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.).
authors: John
authors: J
authors: Chalmers
authors: From the George Institute for Global Health, Neurological and Mental Health Division, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., E.H., C.D., M.W., J.C., C.S.A.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.W.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); and Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.). canderson@georgeinstitute.org.au.
authors: Craig S
authors: CS
authors: Anderson
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000502:physiology*; D002543:Cerebral Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: cerebral hemorrhage; clinical trial; hypertension; treatment outcome