Rapid blood-pressure lowering in acute intracerebral hemorrhage¶

One-paragraph summary¶

INTERACT2 randomized 2,839 patients within six hours of spontaneous ICH and elevated systolic pressure to a target <140 mm Hg within one hour or guideline treatment targeting <180 mm Hg. Death or major disability (mRS 3–6) occurred in 52.0% versus 55.6% (OR 0.87, 95% CI 0.75–1.01; P=0.06). The prespecified ordinal analysis favored intensive treatment (OR for greater disability 0.87, 95% CI 0.77–1.00; P=0.04); mortality was 11.9% versus 12.0% (PMID 23713578).

Key findings¶

2,794 participants had primary-outcome data.
The dichotomous primary endpoint did not reach conventional significance.
The ordinal shift analysis was statistically favorable.
Nonfatal serious adverse events were 23.3% versus 23.6%.

Limitations¶

Open-label BP management and physician-selected agents.
Discordant dichotomous and ordinal results resist a binary “positive/negative” label.
Achieved pressure, timing, and renal/safety tradeoffs affect generalization.

Why it matters¶

INTERACT2 made early smooth BP reduction a major ICH-care component while demonstrating why endpoint choice and modest treatment effects require precise reporting.

Cited by wiki pages¶

overview
intracerebral hemorrhage
clinical trials landscape
guidelines