EBQ:INTERACT-2: Difference between revisions
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==Guidelines== | ==Guidelines== | ||
{{ICH Hypertension Guidelines}} | |||
==Design== | ==Study Design== | ||
==Population== | ==Population== | ||
===Patient Demographics=== | |||
===Inclusion Criteria=== | ===Inclusion Criteria=== | ||
===Exclusion Criteria=== | ===Exclusion Criteria=== | ||
== | ==Interventions== | ||
== | ==Outcomes== | ||
== | ===Primary Outcome=== | ||
=== | ===Secondary Outcomes=== | ||
=== | ===Subgroup analysis=== | ||
== | ==Criticisms & Further Discussion== | ||
==Funding== | ==Funding== | ||
==Sources== | ==Sources== | ||
*[http://www.nejm.org/doi/suppl/10.1056/NEJMoa1214609/suppl_file/nejmoa1214609_protocol.pdf Study Protocol] | |||
*[http://www.nejm.org/doi/suppl/10.1056/NEJMoa1214609/suppl_file/nejmoa1214609_appendix.pdf Supplemental Appendix] | |||
<references/> | <references/> | ||
[[Category:EBQ]][[Category:Neuro]] | |||
Revision as of 16:31, 13 May 2014
PubMed Full text PDF
Clinical Question
Does aggressive and rapid lowering of blood pressure improve outcomes in patients with acute intracerebral hemorrhage?
Conclusion
Intensive lowering of blood pressure in patients with intracerebral hemorrhage, did not result in a significant reduction death or severe disability but does appear to be safe.
Major Points
Prior to INTERACT-2, the INTERACT-1 trial (Intensive blood Bressure Reduction in Acute Cerebral Haemorrhage Trial) functioned as a run-in-phase to the randomized controlled trial for INTERACT-2.[1] INTERACT-1 demonstrated the saftey of intensive BP-lowering and suggested a reduction in hematoma growth with such a strategy paving the way for the subsequent trial focusing on patient centered outcomes.
Similar to INTERACT-1, INTERACT-2 aggressively lowered the systolic blood pressure in emergency department patients with spontaneous atraumatic Intracerebral Hemorrhage (ICH) to a systolic blood pressure of <140 mm Hg within 1 hour and maintained for 7 days. The comparison was made to the current standard care of guideline recommended systolic blood pressure lowering of <180 mm HG within 7 days. The study did not find a death reduction or major disability reduction at 90 days with intensive therapy. Ordinal analysis did suggest improved functional outcomes in the aggressive therapy arm.
Guidelines
AHA Spontaneous ICH BP Guidelines 2015[2]
- If SBP is 150-220mmHg without contraindication to BP lowering, it is safe to acutely lower BP to 140mmHg and can be effective for improving functional outcome. (Class I Level A)
- For ICH patients presenting with SBP >220 mm Hg, it may be reasonable to consider aggressive reduction of BP with a continuous intravenous infusion and frequent BP monitoring (Class IIb; Level of Evidence C)
AHA Aneurysmal SAH BP Guidelines[3]
- No well-controlled studies exist that answer whether BP control influences rebleeding
- BP should be controlled to balance the risk of stroke, hypertension-related rebleeding, and maintenance of cerebral perfusion pressure (Class I, Level of Evidence B).
- Nicardipine, labetalol, and esmolol are appropriate choices for BP control (Sodium nitroprusside may raise intracranial pressure and cause toxicity with prolonged infusion and should be avoided)
Study Design
Population
Patient Demographics
Inclusion Criteria
Exclusion Criteria
Interventions
Outcomes
Primary Outcome
Secondary Outcomes
Subgroup analysis
Criticisms & Further Discussion
Funding
Sources
- ↑ Anderson C. et al. Intensive blood pressure reduction in acute cerebra haemorrhage trial (INTERACT): a randomised pilot trial
- ↑ Hemphill JC, et al. AHA/ASA Guideline: Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2015.
- ↑ Bederson J. et al. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Heart Association. Stroke. 2009;40:994-1025 PDF