Table 1. Summary of randomized, prospective clinical trials studying acute blood pressure management in intracerebral hemorrhage.
| Study (year of
publication) |
Patients | Number
of subjects |
Intervention | Primary outcome | Results |
|---|---|---|---|---|---|
| Rapid blood pressure
reduction in acute ICH (2008) |
Supratentorial ICH
within 8 hours of symptom onset |
42 | MAP <110
versus MAP 110–130 |
Decline in NIHSS ≥2
points at 48 hours, mRS score ≤2 at 90 days, hematoma and edema expansion >30% from baseline volume on 24-hour CT |
No significant differences
in early neurological deterioration ( P = 0.55), hematoma and edema growth ( P = 1.0, P = 0.35), and clinical outcome at 90 days ( P = 0.43). |
| Intensive Blood Pressure
Reduction in Acute Cerebral Hemorrhage (INTERACT) (2008) |
ICH within 6 hours
of symptom onset and SBP 150–220 |
404 | SBP <140 versus
SBP <180 |
Proportional change in
hematoma volume in 24 hours, mRS score of 3–6 at 90 days |
No excess neurological
deterioration or other adverse events in intensively treated group, reduced rate of hematoma growth by 8% ( P = 0.05) |
| Antihypertensive
Treatment in Acute Cerebral Hemorrhage (ATACH) (2010) |
Supratentorial ICH
within 6 hours of symptom onset and SBP ≥200 |
60 | IV nicardipine,
three tiers of SBP: 170–200 140–170 110–140 |
Neurological
deterioration within 24 hours, serious adverse events within 72 hours |
Low rate of serious
adverse events and neurological deterioration among all three tiers. No difference in average SBP change between patients with and without neurological deterioration ( P = 0.47) |
| Intracerebral Hemorrhage
Acutely Decreasing Blood Pressure Trial (ICH-ADAPT) (2013) |
ICH within 24 hours
of symptom onset and SBP ≥150 |
82 | IV labetalol,
SBP <150 versus <180 |
Perihematoma rCBF
on CT perfusion, 2 hours after treatment |
Peri-hematoma rCBF was
not lower among patients randomly assigned to SBP <150 ( P = 0.18) |
| INTERACT2 (2016) | ICH within 6 hours
of symptom onset, SBP 150–220 |
2,794 | SBP <140 within
1 hours versus SBP <180 |
Death or mRS score
>2 at 90 days |
No significant change in
the rate of death or major disability. Trend toward improved functional outcome on ordinal analysis. OR 0.87 (95% CI 0.75–1.01, P = 0.06) |
| ATACH-2 (2016) | Supratentorial ICH
within 4.5 hours of symptom onset, SBP ≥180 |
1,000 | SBP 110–139
versus SBP 140–179 |
Death or mRS score of
4–6 at 90 days |
No difference in the rate of
death or severe disability ( P = 0.72). Higher rate of renal complications in 7 days among treatment arm ( P = 0.002) |
Blood pressure is presented in millimeters of mercury (mm Hg). CI, confidence interval; CT, computed tomography; ICH, intracerebral hemorrhage; IV, intravenous; MAP, mean arterial pressure; mRS, modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; OR, odds ratio; rCBF, relative cerebral blood flow; SBP, systolic blood pressure.