Early, Aggressive Blood Pressure Lowering Tied to Better Intracerebral Hemorrhage( ICH) Outcomes
Early, Aggressive Blood Pressure Lowering Tied to Better Intracerebral Hemorrhage( ICH) Outcomes
Source: Medscape June 19, 2025 | -Published in -The Lancet June 18, 2025
Key Findings (Pooled Analysis – INTERACT1–4 Trials):
1. Early intensive BP lowering within 3 hours of ICH symptom onset is associated with:
• Improved neurological recovery
• Lower rates of death
• Fewer serious adverse events
2. Treatment groups:
• Intensive group target: SBP <140 mm Hg within 1 hour
• Standard guideline group: SBP <180 mm Hg within 1 hour
3. Study population:
• More than 11,000 patients across four randomized trials (INTERACT1–4)
• All had acute ICH with SBP >150 mm Hg
4. Outcomes:
• Better functional recovery (lower modified Rankin scores)
• Reduced neurological deterioration within 7 days (OR = 0.76)
• Fewer serious adverse events (OR = 0.84)
• Lower mortality (OR = 0.83)
5. CT sub-analysis (~3,000 patients):
• No significant change in hematoma size overall
• But 25% of patients treated within 3 hours had reduced hematoma growth
6. Editorial insight:
• Dr. David Werring emphasized the timing difference between ischemic stroke and ICH
• Early BP lowering may reduce hematoma expansion, a key driver of poor outcomes in ICH
• Still, potential risks and confounding variables (especially in INTERACT3) require further study
Takeaway:
Ischemic stroke:
• Be cautious with early BP lowering.
• Preserve cerebral perfusion.
Hemorrhagic stroke (ICH):
• Early intensive BP lowering (within 3 hours) is beneficial.
• Reduces risk of hematoma expansion and improves neurological outcomes.
Conclusion:
“Earlier is better — once again, time is brain for ICH.”
Ultra-early intensive BP reduction appears safe and beneficial, especially within the first 3 hours.