Effects of Early Intensive Blood Pressure-Lowering Treatment on the Growth of Hematoma and Perihematomal Edema in Acute Intracerebral Hemorrhage

The Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT)

Craig S. Anderson, MD;
Yining Huang, MD;
Hisatomi Arima, MD;
Emma Heeley, PhD;
Christian Skulina, MD;
Mark W. Parsons, MD;
Bin Peng, MD;
Qiang Li, BSc;
Steve Su, PhD;
Qing Ling Tao, MD;
Yue Chun Li, MD;
Jian Dong Jiang, MD;
Li Wen Tai, MD;
Jin Li Zhang, MD;
En Xu, MD;
Yan Cheng, MD;
Lewis B. Morgenstern, MD;
John Chalmers, MD;
Ji Guang Wang, MD;
for the INTERACT Investigators

+ Author Affiliations

From The George Institute for International Health (C.S.A., H.A., E.H., C.S., Q.L., J.C.), Royal Prince Alfred Hospital and the University of Sydney, Sydney, Australia; Peking University First Hospital (Y.H.), Beijing, China; John Hunter Hospital and the Hunter Medical Research Institute (M.W.P.), University of Newcastle, New Lambton, Australia; Peking Union Medical College Hospital (B.P.), Beijing, China; School of Mathematics and Statistics (S.S.), The University of Western Australia, Perth, Australia; Central Hospital (Q.L.T.), Changning District of Shanghai, Shanghai, China; Baotou Central Hospital (Y.C.L.), Baotou, China; The First Hospital of Nanjing (J.D.J.), Nanjing, China; Second Hospital of Hebei Medical University (L.W.T.), Shijiazhuang, China; The Chinese PLA No. 263 Hospital (J.L.Z.), Beijing, China; The Second Affiliated Hospital of Guangzhou Medical College (E.X.), Guangzhou, China; General Hospital of Tianjin Medical University (Y.C.), Tianjin, China; University of Michigan Medical School (L.B.M.), Ann Arbor, Mich; and Shanghai Institute of Hypertension (J.G.W.), Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China.

Correspondence to Craig S. Anderson, MD, The George Institute for International Health, Royal Prince Alfred Hospital and the University of Sydney, PO Box M201, Missenden Road, NSW 2050, Australia. E-mail canderson@george.org.au

Abstract

Background and Purpose—The Intensive Blood Pressure Reduction In Acute Cerebral Haemorrhage Trial (INTERACT) study suggests that early intensive blood pressure (BP) lowering can attenuate hematoma growth at 24 hours after intracerebral hemorrhage. The present analyses aimed to determine the effects of treatment on hematoma and perihematomal edema over 72 hours.

Methods—INTERACT included 404 patients with CT-confirmed intracerebral hemorrhage, elevated systolic BP (150 to 220 mm Hg), and capacity to start BP-lowering treatment within 6 hours of intracerebral hemorrhage. Patients were randomly assigned to an intensive (target systolic BP 140 mmHg) or standard guideline-based management of BP (target systolic BP 180 mm Hg) using routine intravenous agents. Baseline and repeat CTs (24 and 72 hours) were performed using standardized techniques with digital images analyzed centrally. Outcomes were increases in hematoma and perihematomal edema volumes over 72 hours.

Results—Overall, 296 patients had all 3 CT scans available for the hematoma and 270 for the edema analyses. Mean systolic BP was 11.7 mm Hg lower in the intensive group than in the guideline group during 1 to 24 hours. Adjusted mean absolute increases in hematoma volumes (mL) at 24 and 72 hours were 2.40 and 0.15 in the guideline group compared with −0.74 and −2.31 in the intensive group, respectively, an overall difference of 2.80 (95% CI, 1.04 to 4.56; P=0.002). Adjusted mean absolute increases in edema volumes (mL) at 24 and 72 hours were 6.27 and 10.02 in the guideline group compared with 4.19 and 7.34 in the intensive group, respectively, for an overall difference of 2.38 (95% CI, −0.45 to 5.22; P=0.10).

Conclusion—Early intensive BP-lowering treatment attenuated hematoma growth over 72 hours in intracerebral hemorrhage. There were no appreciable effects on perihematomal edema.

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