title: Early blood pressure lowering in patients with intracerebral haemorrhage and prior use of antithrombotic agents: pooled analysis of the INTERACT studies.
abstract: OBJECTIVE
  Antithrombotic agents increase risks of intracerebral haemorrhage (ICH) and associated adverse outcomes. We determined differential effects of early blood pressure (BP) lowering in patients with/without antithrombotic-associated ICH in the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trials (INTERACT1 and 2).
  
  
  METHODS
  Post hoc pooled analyses of the INTERACT studies-international, multicentre, prospective, open, blinded end point trials of patients with ICH (<6 h) and elevated systolic BP (SBP 150-180 mm Hg) randomly assigned to intensive (target SBP <140 mm Hg) or guideline-based (SBP <180 mm Hg) BP management. Associations of antithrombotic use and (1) death or dependency (modified Rankin scale scores 3-6) were analysed using logistic regression, and (2) of increased haematoma+intraventricular haemorrhage volume (IVH) with/without intraventricular haemorrhage (IVH) over 24 h were estimated in analyses of covariance.
  
  
  RESULTS
  In all, 3184 patients were included in these analyses. Antithrombotic-associated ICH (364 patients, 11%) was not associated with a significantly increased risk of death or dependency (OR 1.38, 95% CI 0.93 to 2.04). There was no heterogeneity in the BP-lowering treatment effect on death or dependency. Among 1309 patients who underwent follow-up CT after 24 h, absolute increase in haematoma±IVH volume was larger (5.2/5.0 mL) in those with compared to those without prior antithrombotics (2.2/0.9 mL; p=0.022/0.031). Intensive BP lowering reduced haematoma±IVH growth by 4.7/7.1 mL in patients on antithrombotics versus 1.3/1.4 mL in those without, although these differences did not reach statistical significance (p homogeneity=0.104/0.059).
  
  
  CONCLUSIONS
  In patients with ICH, prior antithrombotic therapy is associated with greater haematoma growth, which may be reduced by early intensive BP-lowering treatment.
  
  
  BACKGROUND
  NCT00226096, NCT00716079.
authors.affiliation: Department of Neurology, Shanghai 85th Hospital of PLA, Shanghai, China.
authors.forename: Lili
authors.initials: L
authors.lastname: Song
authors.affiliation: Department of Neurology, Oslo University Hospital, Oslo, Norway.|The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Else Charlotte
authors.initials: EC
authors.lastname: Sandset
authors.affiliation: The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Hisatomi
authors.initials: H
authors.lastname: Arima
authors.affiliation: The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Heeley
authors.affiliation: The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Candice
authors.initials: C
authors.lastname: Delcourt
authors.affiliation: Department of Neurology, Xuzhou Central Hospital, Xuzhou, China.
authors.forename: Guofeng
authors.initials: G
authors.lastname: Chen
authors.affiliation: Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Neurology, Hebei Yutian Hospital, Yutian, China.
authors.forename: Guojun
authors.initials: G
authors.lastname: Wu
authors.affiliation: The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Xia
authors.initials: X
authors.lastname: Wang
authors.affiliation: Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, and Universidad de Chile, Santiago, Chile.
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Lavados
authors.affiliation: Department of Neurology, Peking University First Hospital, Beijing, China.
authors.forename: Yining
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Neuroscience, CRCHUM, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: Stapf
authors.affiliation: The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Jiguang
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK.
authors.forename: Thompson G
authors.initials: TG
authors.lastname: Robinson
authors.affiliation: The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.affiliation: The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Richard I
authors.initials: RI
authors.lastname: Lindley
authors.affiliation: The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Anderson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000401:mortality; D004185:Disability Evaluation; D004311:Double-Blind Method; D061345:Early Medical Intervention; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D012306:Risk; D013223:Statistics as Topic
chemical_list: D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents