title: Degree and Timing of Intensive Blood Pressure Lowering on Hematoma Growth in Intracerebral Hemorrhage: Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial-2 Results.
abstract: Degree and timing of blood pressure (BP) lowering treatment in relation to hematoma growth were investigated in the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial-2 (INTERACT2).
  
  
  
  INTERACT2 was an international clinical trial of intensive (target systolic BP [SBP], <140 mm Hg) versus guideline-recommended (SBP, <180 mm Hg) BP lowering in 2839 patients within 6 hours of spontaneous intracerebral hemorrhage and elevated SBP (150-220 mm Hg), in which 964 had repeat cranial computed tomography at 24 hours. ANCOVA models assessed categories of SBP reduction and time to target SBP on 24-hour hematoma growth.
  
  
  
  Greater SBP reduction was associated with reduced hematoma growth (13.3, 5.0, and 3.0 mL for <10, 10-20, and ≥20 mm Hg, respectively; P trend<0.001). In the intensive treatment group (n=491), the least mean hematoma growth was in patients who achieved target SBP <1 hour (2.6 mL) versus to those in target at 1 to 6 (4.7 mL) and >6 hours (5.4 mL). The smallest mean absolute hematoma growth (2.0 mL) was in those achieving target SBP 5 to 8 times versus 3 to 4 (3.1 mL) and 0 to 2 times (5.2 mL).
  
  
  
  Intensive BP lowering with greater SBP reduction, which is achieved quickly and maintained consistently, seems to provide protection against hematoma growth for 24 hours.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00716079.
authors.affiliation: From the Neurological and Mental Health Division, The George Institute for Global Health, Sydney, New South Wales, Australia (C.C., X.W., S.S., E.C.S., C.D., H.A., J.C., C.S.A.); Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia (C.C., X.W., C.D., J.C., C.S.A.); Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (C.C, C.D, J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada (C.S.); Department of Neurology, Oslo University Hospital, Oslo, Norway (E.C.S.); Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan (H.A.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); Unidad de Neurología vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Santiago, Chile (P.L.); and Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile (P.L.).
authors.forename: Cheryl
authors.initials: C
authors.lastname: Carcel
authors.affiliation: From the Neurological and Mental Health Division, The George Institute for Global Health, Sydney, New South Wales, Australia (C.C., X.W., S.S., E.C.S., C.D., H.A., J.C., C.S.A.); Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia (C.C., X.W., C.D., J.C., C.S.A.); Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (C.C, C.D, J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada (C.S.); Department of Neurology, Oslo University Hospital, Oslo, Norway (E.C.S.); Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan (H.A.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); Unidad de Neurología vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Santiago, Chile (P.L.); and Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile (P.L.).
authors.forename: Xia
authors.initials: X
authors.lastname: Wang
authors.affiliation: From the Neurological and Mental Health Division, The George Institute for Global Health, Sydney, New South Wales, Australia (C.C., X.W., S.S., E.C.S., C.D., H.A., J.C., C.S.A.); Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia (C.C., X.W., C.D., J.C., C.S.A.); Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (C.C, C.D, J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada (C.S.); Department of Neurology, Oslo University Hospital, Oslo, Norway (E.C.S.); Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan (H.A.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); Unidad de Neurología vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Santiago, Chile (P.L.); and Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile (P.L.).
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Sato
authors.affiliation: From the Neurological and Mental Health Division, The George Institute for Global Health, Sydney, New South Wales, Australia (C.C., X.W., S.S., E.C.S., C.D., H.A., J.C., C.S.A.); Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia (C.C., X.W., C.D., J.C., C.S.A.); Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (C.C, C.D, J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada (C.S.); Department of Neurology, Oslo University Hospital, Oslo, Norway (E.C.S.); Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan (H.A.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); Unidad de Neurología vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Santiago, Chile (P.L.); and Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile (P.L.).
authors.forename: Christian
authors.initials: C
authors.lastname: Stapf
authors.affiliation: From the Neurological and Mental Health Division, The George Institute for Global Health, Sydney, New South Wales, Australia (C.C., X.W., S.S., E.C.S., C.D., H.A., J.C., C.S.A.); Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia (C.C., X.W., C.D., J.C., C.S.A.); Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (C.C, C.D, J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada (C.S.); Department of Neurology, Oslo University Hospital, Oslo, Norway (E.C.S.); Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan (H.A.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); Unidad de Neurología vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Santiago, Chile (P.L.); and Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile (P.L.).
authors.forename: Else Charlotte
authors.initials: EC
authors.lastname: Sandset
authors.affiliation: From the Neurological and Mental Health Division, The George Institute for Global Health, Sydney, New South Wales, Australia (C.C., X.W., S.S., E.C.S., C.D., H.A., J.C., C.S.A.); Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia (C.C., X.W., C.D., J.C., C.S.A.); Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (C.C, C.D, J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada (C.S.); Department of Neurology, Oslo University Hospital, Oslo, Norway (E.C.S.); Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan (H.A.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); Unidad de Neurología vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Santiago, Chile (P.L.); and Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile (P.L.).
authors.forename: Candice
authors.initials: C
authors.lastname: Delcourt
authors.affiliation: From the Neurological and Mental Health Division, The George Institute for Global Health, Sydney, New South Wales, Australia (C.C., X.W., S.S., E.C.S., C.D., H.A., J.C., C.S.A.); Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia (C.C., X.W., C.D., J.C., C.S.A.); Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (C.C, C.D, J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada (C.S.); Department of Neurology, Oslo University Hospital, Oslo, Norway (E.C.S.); Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan (H.A.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); Unidad de Neurología vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Santiago, Chile (P.L.); and Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile (P.L.).
authors.forename: Hisatomi
authors.initials: H
authors.lastname: Arima
authors.affiliation: From the Neurological and Mental Health Division, The George Institute for Global Health, Sydney, New South Wales, Australia (C.C., X.W., S.S., E.C.S., C.D., H.A., J.C., C.S.A.); Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia (C.C., X.W., C.D., J.C., C.S.A.); Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (C.C, C.D, J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada (C.S.); Department of Neurology, Oslo University Hospital, Oslo, Norway (E.C.S.); Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan (H.A.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); Unidad de Neurología vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Santiago, Chile (P.L.); and Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile (P.L.).
authors.forename: Thompson
authors.initials: T
authors.lastname: Robinson
authors.affiliation: From the Neurological and Mental Health Division, The George Institute for Global Health, Sydney, New South Wales, Australia (C.C., X.W., S.S., E.C.S., C.D., H.A., J.C., C.S.A.); Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia (C.C., X.W., C.D., J.C., C.S.A.); Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (C.C, C.D, J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada (C.S.); Department of Neurology, Oslo University Hospital, Oslo, Norway (E.C.S.); Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan (H.A.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); Unidad de Neurología vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Santiago, Chile (P.L.); and Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile (P.L.).
authors.forename: Pablo
authors.initials: P
authors.lastname: Lavados
authors.affiliation: From the Neurological and Mental Health Division, The George Institute for Global Health, Sydney, New South Wales, Australia (C.C., X.W., S.S., E.C.S., C.D., H.A., J.C., C.S.A.); Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia (C.C., X.W., C.D., J.C., C.S.A.); Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (C.C, C.D, J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada (C.S.); Department of Neurology, Oslo University Hospital, Oslo, Norway (E.C.S.); Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan (H.A.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); Unidad de Neurología vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Santiago, Chile (P.L.); and Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile (P.L.).
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.affiliation: From the Neurological and Mental Health Division, The George Institute for Global Health, Sydney, New South Wales, Australia (C.C., X.W., S.S., E.C.S., C.D., H.A., J.C., C.S.A.); Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia (C.C., X.W., C.D., J.C., C.S.A.); Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (C.C, C.D, J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada (C.S.); Department of Neurology, Oslo University Hospital, Oslo, Norway (E.C.S.); Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan (H.A.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); Unidad de Neurología vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Santiago, Chile (P.L.); and Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile (P.L.). canderson@georgeinstitute.org.au.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Anderson
mesh_terms: D000208:Acute Disease; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000188:drug therapy*; D003422:Critical Care / Q000379:methods*; D006406:Hematoma / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic
chemical_list: D000959:Antihypertensive Agents
keywords: blood pressure; cerebral hemorrhage; hematoma; tomography