Interpretation and Implementation of Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT II).

The second Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT II)1 randomized 2,839 patients with intracerebral hemorrhage (ICH) within 6 h of symptom onset to intensive systolic blood pressure (SBP) reduction, with a target of <140 mm Hg within 1 h, or guideline-recommended SBP reduction, with a target of <180 mm Hg using a variety of antihypertensive medications. The primary outcome was death or major disability defined by a score of 3–6 on the modified Rankin scale (mRS) at 3 months post-randomization. The proportion of subjects with death or major disability was 719 of 1,382 (52%) in the group randomized to receive intensive BP reduction compared with 785 of 1,412 (55.6%) in the group randomized to receive guideline-recommended treatment (odds ratio [OR] with intensive treatment, 0.87; 95% confidence interval [CI], 0.75–1.01; p = 0.06). In the secondary analysis, mRS grades were analyzed as an ordinal scale, which detected significantly lower mRS scores in subjects randomized to intensive SBP reduction (common OR, 0.87; 95% CI, 0.77–1.00; p = 0.04).