Early control of systolic blood pressure following intracerebral hemorrhage may improve functional recovery

1. Maintaining systolic blood pressure in a lower, stable range during the first 24 hours after intracerebral hemorrhage was associated with the best 90-day functional outcomes.

2. Patients with persistently severe hypertension had the highest risk of poor outcome, supporting a tailored rather than uniformly aggressive blood pressure strategy.

Evidence Rating Level: 2 (Good)

This pooled individual patient-level post hoc analysis evaluated whether early systolic blood pressure patterns after acute intracerebral hemorrhage were associated with 90-day outcomes. The investigators combined data from the four INTERACT trials and ATACH-II, including 11,269 patients with at least one post-randomization blood pressure measurement. Using latent class analysis, they identified six systolic blood pressure trajectories over the first 24 hours: low, moderate-to-low, moderate, high, high-to-moderate, and high-to-low. The primary outcome was a poor functional outcome at 90 days, defined as a modified Rankin Scale score of 3 to 6. In the INTERACT cohorts, patients in the low trajectory group, with blood pressure falling from a mean baseline of about 149 mm Hg to 120 to 130 mm Hg over 24 hours, had the best outcomes. Compared with this group, the odds of poor functional outcome increased across the higher trajectory groups, with the worst outcomes seen in the high-to-moderate group. A similar direction of effect was seen in ATACH-II, although this was not statistically significant. Mortality and serious cardiac or renal adverse events did not differ significantly across trajectories. Overall, the study suggests that early, sustained, and well-controlled systolic blood pressure reduction is associated with better functional recovery after intracerebral hemorrhage, whereas persistently severe hypertension identifies a high-risk subgroup that may need more individualized treatment.

Click here to read this study in Neurology

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