Optimal achieved blood pressure in acute intracerebral hemorrhage: INTERACT2

Hisatomi Arima; Emma Heeley; Candice Delcourt; Yoichiro Hirakawa; Xia Wang; Mark Woodward; Thompson Robinson; Christian Stapf; Mark Parsons; Pablo M Lavados; Yining Huang; Jiguang Wang; John Chalmers; Craig S Anderson; INTERACT2 Investigators; INTERACT2 Investigators

doi:10.1212/WNL.0000000000001205

Optimal achieved blood pressure in acute intracerebral hemorrhage: INTERACT2

Neurology. 2015 Feb 3;84(5):464-71. doi: 10.1212/WNL.0000000000001205. Epub 2014 Dec 31.

Authors

Collaborators

C S Anderson, J Chalmers, H Arima, S Davis, E Heeley, Y Huang, P Lavados, B Neal, M W Parsons, R Lindley, L Morgenstern, T Robinson, C Stapf, C Tzourio, J G Wang, Y Huang, S Chen, X Y Chen, L Cui, Z Liu, C Lu, J Wang, S Wu, E Xu, Q Yang, C Zhang, J Zhang, R Beer, E Schmutzhard, P Redondo, M Kaste, L Soinne, T Tatlisumak, C Stapf, K Wartenberg, S Ricci, K Klijn, E Azevedo, A Chamorro, M Arnold, U Fischer, S Kaul, J Pandian, H Boyini, S Singh, A A Rabinstein, C Estol, G Silva, P Lavados, V V Olavarria, T G Robinson, R J Simes, M-G Bousser, G Hankey, K Jamrozik, S C Johnston, S Li, E Heeley, C S Anderson, K Bailey, J Chalmers, T Cheung, C Delcourt, S Chintapatla, E Ducasse, T Erho, J Hata, B Holder, E Knight, R Lindley, M Leroux, T Sassé, E Odgers, R Walsh, Z Wolfowicz, C S Anderson, G Chen, C Delcourt, S Fuentes, R Lindley, B Peng, H-M Schneble, M-X Wang, H Arima, L Billot, S Heritier, Q Li, M Woodward, C Delcourt, S Abimbola, S Anderson, E Chan, G Cheng, P Chmielnik, J Hata, S Leighton, J-Y Liu, B Rasmussen, A Saxena, S Tripathy, M Armenis, M A Baig, B Naidu, G Starzec, S Steley, C S Anderson, E Heeley, M Leroux, C Delcourt, T Sassé, E Knight, K Bailey, T Cheung, E Odgers, E Ducasse, B Holder, Z Wolfowicz, R Walsh, S Chintapatla, T Erho, C Estol, A Moles, A Ruiz, M Zimmermann, J Marinho, S Alves, R Angelim, J Araujo, L Kawakami, P Lavados, V V Olavarria, C Bustos, F Gonzalez, P Munoz Venturelli, Y Huang, X Chen, Y Huang, R Jia, N Li, S Qu, Y Shu, A Song, J Sun, J Xiao, Y Zhao, J-G Wang, Q Huang, C Stapf, E Vicaut, A Chamam, M-C Viaud, C Dert, U Fiedler, V Jovis, S Kabla, S Marchand, A Pena, V Rochaud, K Mallikarjuna, H Boyini, N Hasan, E Berge, E C Sandset, A S Forårsveen, T Robinson, D Richardson, T Kumar, S Lewin, N Poulter, J Field, A Anjum, A Wilson, H Perelmuter, A M Agarie, A G Barboza, L A Recchia, I F Miranda, S G Rauek, R J Duplessis, H Dewey, L Walker, S Petrolo, C Bladin, J Sturm, D Crimmins, D Griffiths, A Schutz, V Zenteno, M W Parsons, F Miteff, N Spratt, E Kerr, C R Levi, T G Phan, H Ma, L Sanders, C Moran, K Wong, S Read, R Henderson, A Wong, R Hull, G Skinner, S Davis, P Hand, B Yan, H Tu, B Campbell, C S Anderson, C Delcourt, D J Blacker, T Wijeratne, M Pathirage, M Jasinararchchi, Z Matkovic, S Celestino, F Gruber, M R Vosko, E Diabl, S Rathmaier, R Beer, E Schmutzhard, B Pfausler, R Helbok, F Fazekas, R Fischer, B Poltrum, B Zechner, U Trummer, M P Rutgers, A Peeters, A Dusart, M-C Duray, C Parmentier, S Ferrao-Santos, R Brouns, S De Raedt, A De Smedt, R-J Van Hooff, J De Keyser, S C O Martins, A G de Almeida, R Broudani, N F Titton, G R de Freitas, F M Cardoso, L M Giesel, N A Lima Junior, A C Ferraz de Almeida, R B Gomes, T S Borges Dos Santos, E M Veloso Soares, O L A Neto, G S Silva, D L Gomes, F A de Carvalho, M Miranda, A Marques, V F Zétola, G de Matia, M C Lange, J Montes, A Reccius, P Munoz Venturelli, V V Olavarria, A Soto, R Rivas, C Klapp, S Illanes, C Aguilera, A Castro, C Figueroa, J Benavides, P Salamanca, M C Concha, J Pajarito, P Araya, F Guerra, Y Li, G Liu, B Wang, J Zhang, Y Chong, M He, L Wang, J Liu, X Zhang, C Lai, H Jiang, Q Yang, S Cui, Q Tao, Y Zhang, S Yao, M Xu, Y Zhang, Z Liu, H Xiao, J Hu, J Tang, J Sun, H Ji, M Jiang, F Yu, Y Zhang, X Yang, X Guo, Y Wang, L Wu, Z Liu, Y Gao, D Sun, X Huang, Y Wang, L Liu, Y Li, P Li, Y Jiang, H Li, H Lu, J Zhou, C Yuan, X Qi, F Qiu, H Qian, W Wang, J Liu, Y Huang, W Sun, F Li, R Liu, Q Peng, Z Ren, C Fan, Y Zhang, H Wang, T Wang, F Shi, C Duan, S Chen, J Wang, Z Chen, X Tan, Z Zhao, Y Gao, J Chen, T Han, S Wu, L Zhang, L Wang, Q Hu, Q Hou, X Zhao, L Wang, G Zeng, L Ma, F Wang, S Chen, L Zeng, Z Guo, Y Fu, Y Song, L Tai, X Liu, X Su, Y Yang, R Dong, Y Xu, S Tian, S Cheng, L Su, X Xie, T Xu, D Geng, X Yan, H Fan, N Zhao, S Wang, J Yang, J Zhang, M Yan, L Li, Z Li, X Xu, F Wang, L Wu, X Guo, Y Lian, H Sun, D Liu, N Wang, Q Tang, Z Han, L Feng, Y Cui, J Tian, H Chang, X Sun, J Wang, C Liu, Z Wen, E Xu, Q Lin, X Zhang, L Sun, B Hu, M Zou, Q Bao, X Lin, L Zhao, X Tian, H Wang, X Wang, X Li, L Hao, Y Duan, R Wang, Z Wei, J Liu, S Ren, H Ren, Y Wang, Y Dong, Y Cheng, M Zou, W Liu, J Han, C Zhang, Z Zhang, J Zhu, Y Wang, Q Li, J Qian, Y Sun, K Liu, F Long, X Peng, Q Zhang, Z Yuan, C Wang, M Huang, J Zhang, F Wang, P He, Y You, X Wang, Q Yang, H Wang, J Xia, L Zhou, Y Hou, Y Wang, L Liu, Y Qi, L Mei, R Lu, G Chen, L Liu, L Ping, W Liu, S Zhou, J Wang, L Wang, H Li, S Zhang, L Wang, R Zou, J Guo, M Li, W Wei, L Soinne, S Curtze, M Saarela, D Strbian, F Scheperjans, T De Broucker, C Henry, R Cumurciuc, N Ibos-Augé, A-C Zéghoudi, F Pico, O Dereeper, M-C Simian, C Boisselier, A Mahfoud, S Timsit, F M Merrien, B Guillon, M Sevin, F Herisson, C Magne, A Ameri, C Cret, S Stefanizzi, F Klapzcynski, C Denier, M Sarov-Riviere, C Stapf, P Reiner, J Mawet, D Hervé, F Buffon, E Touzé, V Domigo, C Lamy, D Calvet, M Pasquini, S Alamowitch, P Favrole, I-P Muresan, S Crozier, C Rosso, C Pires, A Leger, S Deltour, C Cordonnier, H Henon, C Rossi, M Zuber, M Bruandet, R Tamazyan, C Join-Lambert, E Juettler, T Krause, S Maul, M Endres, G J Jungehulsing, M Hennerici, M Griebe, T Sauer, K Knoll, R Huber, K Knauer, C Knauer, S Raubold, H Schneider, H Hentschel, C Lautenschläger, E Schimmel, I Dzialowski, C Foerch, M Lorenz, O Singer, I M R Meyer Dos Santos, A Hartmann, A Hamann, A Schacht, B Schrader, A Teíchmann, K E Wartenberg, T J Mueller, S Jander, M Gliem, C Boettcher, M Rosenkranz, C Beck, D Otto, G Thomalla, B Cheng, K S Wong, T W Leung, Y O Y Soo, S Prabhakar, S R Kesavarapu, P K Gajjela, R R K Ummer, M Basheer, A Andipet, A U R Mohammed, V G Pawar, S S K Eranki, J Pandian, Y Singh, N Akhtar, N C Borah, M Ghose, N Choudhury, N R Ichaporia, J Shendge, S Khese, V Pamidimukkala, P Inbamuthaiah, S R Nuthakki, N M R Tagallamudi, A K Gutti, D Khurana, P Kesavarapu, V Jogi, A Garg, D Samanta, G R K Sarma, R Nadig, T Mathew, M A Anandan, E Caterbi, A Zini, M Cavazzuti, F Casoni, R Pentore, F Falzone, S Ricci, T Mazzoli, L M Greco, C Menichetti, F Coppola, S Cenciarelli, E Gallinella, A Mattioni, R Condurso, I Sicilia, M Zampolini, F Corea, M Barbi, C Proietti, D Toni, A Pieroni, A Anzini, A Falcou, M Demichele, C J M Klijn, A Tveiten, E T Thortveit, S Pettersen, N Holand, B Hitland, S H Johnsen, A Eltoft, A Kamal, A Iqrar, L Ali, D Begum, G Gama, E Azevedo, L Fonseca, G Moreira, L M Veloso, D Pinheiro, L Paredes, C Rozeira, T Gregorio, T Segura Martin, O Ayo, J Garcia-Garcia, I Feria Vilar, I Gómez Fernández, A Chamorro, S Amaro, X Urra, V Obach, A Cervera, Y Silva, J Serena, M Castellanos, M Terceno, C Van Eendenburg, U Fischer, M Arnold, A Weck, O Findling, R Lüdi, E A Warburton, D Day, N Butler, E Bumanlag, S Caine, A Steele, M Osborn, E Dodd, P Murphy, B Esisi, E Brown, R Hayman, V K V Baliga, M Minphone, J Kennedy, I Reckless, G Pope, R Teal, K Michael, D Manawadu, L Kalra, R Lewis, B Mistry, E Cattermole, A Hassan, L Mandizvidza, J Bamford, H Brooks, C Bedford, R Whiting, P Baines, M Hussain, M Harvey, K Fotherby, S McBride, P Bourke, D Morgan, K Jennings-Preece, C Price, S Huntley, V E Riddell, G Storey, R L Lakey, G Subramanian, D Jenkinson, J Kwan, O David, D Tiwari, M James, S Keenan, H Eastwood, L Shaw, P Kaye, D Button, B Madigan, D Williamson, A Dixit, J Davis, M O Hossain, G A Ford, A Parry-Jones, V O'Loughlin, R Jarapa, Z Naing, C Lovelock, J O'Reilly, U Khan, A Bhalla, A Rudd, J Birns, D J Werring, R Law, R Perry, I Jones, R Erande, C Roffe, I Natarajan, N Ahmad, K Finney, J Lucas, A Mistri, D Eveson, R Marsh, V Haunton, T Robinson, A A Rabinstein, J E Fugate, S W Lepore

Affiliations

¹ 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.
² 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.

Abstract

Objectives: 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.

Classification of evidence: This study provides Class I evidence that the effect of intensive BP lowering on physical function is not influenced by baseline BP.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Acute Disease
Aged
Antihypertensive Agents / therapeutic use
Blood Pressure Determination / methods
Blood Pressure*
Cerebral Hemorrhage / diagnosis*
Cerebral Hemorrhage / physiopathology
Cerebral Hemorrhage / therapy*
Female
Humans
Hypertension / diagnosis*
Hypertension / physiopathology
Hypertension / therapy*
Internationality*
Male
Middle Aged
Single-Blind Method
Treatment Outcome

Substances

Antihypertensive Agents