EBQ:INTERACT-2

Under Review Journal Club Article

Anderson C. et al. "Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial.". NEJM. 2013. 368(25):2355-2365.
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. 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.