Early Blood Pressure Lowering Does Not Reduce Growth of Intraventricular Hemorrhage following Acute Intracerebral Hemorrhage: Results of the INTERACT Studies

Abstract

Background: Intraventricular hemorrhage (IVH) extension is common following acute intracerebral hemorrhage (ICH) and is associated with poor prognosis.

Aim: To determine whether intensive blood pressure (BP)-lowering therapy reduces IVH growth.

Methods: Pooled analyses of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials (INTERACT1 and INTERACT2) computed tomography (CT) substudies; multicenter, open, controlled, randomized trials of patients with acute spontaneous ICH and elevated systolic BP, randomly assigned to intensive (<140 mm Hg) or guideline-based (<180 mm Hg) BP management. Participants had blinded central analyses of baseline and 24-hour CT. Association of BP lowering to IVH growth was assessed in analysis of covariance.

Results: There was no significant difference in adjusted mean IVH growth following intensive (n = 228) compared to guideline-recommended (n = 228) BP treatment (1.6 versus 2.2 ml, respectively; p = 0.56). Adjusted mean IVH growth was nonsignificantly greater in patients with a mean achieved systolic BP ≥160 mm Hg over 24 h (3.94 ml; p trend = 0.26).

Conclusions: Early intensive BP-lowering treatment had no clear effect on IVH in acute ICH.

Keywords: Hypertension; Intensive blood pressure lowering; Intracerebral hemorrhage; Intraventricular hemorrhage; Stroke.

Fig. 1

Intraventricular volume growth by average achieved BP between 1 and 24 h after randomization. ^† Assessed by ANCOVA adjusting for age, sex, China region, use of statin, baseline systolic BP, randomized treatment, baseline IVH volume, and ICH location. Because of skewed raw data, adjusted means are reported with 95% confidence intervals obtained by back-transformation.