Aggressive Blood Pressure Control Improves Stroke Outcomes

Early Intervention is Key for Better Recovery and Reduced Risks

New research reveals that swiftly lowering blood pressure after an intracerebral hemorrhage (ICH) can significantly improve patient outcomes, potentially saving lives. Prompt treatment, especially within the first few hours, leads to better neurological function, fewer adverse events, and reduced mortality rates for those suffering from this type of stroke.

Early Treatment Yields Stronger Results

A pooled analysis of four Intensive BP Reduction in Acute Cerebral Hemorrhage Trials (INTERACT1-4) has confirmed the benefits of early, intensive blood pressure management for individuals experiencing ICH. The most positive results were found when the intervention was administered within three hours of the onset of ICH symptoms. Current guidelines suggest a systolic BP target of less than 180 mm Hg within one hour of symptom onset, whereas the intensive treatment approach aims for less than 140 mm Hg within the same timeframe.

The studies involved over 10,000 adults with acute ICH. Participants were randomly assigned to receive either intensive or guideline-recommended BP-lowering treatment within an hour of symptom onset. The primary outcome measure was functional recovery, determined using the modified Rankin scale. The intensive treatment group showed significantly lower mean systolic BP rates at one hour compared to the guideline group, 149.6 mm Hg versus 158.8 mm Hg, respectively.

“The data presented make a compelling case for ultra-early intensive blood pressure reduction as a potentially useful intervention to improve outcomes in people with acute ICH.”

—David J. Werring, PhD, Department of Translational Neuroscience and Stroke, University College London Queen Square Institute of Neurology, London

Those receiving intensive treatment also experienced reduced odds of neurological deterioration within seven days, along with fewer serious adverse events and deaths. According to the American Stroke Association, stroke is a leading cause of death in the United States, with nearly 800,000 strokes occurring annually (American Stroke Association).

Timing and Impact on Hematoma Growth

Investigators also assessed the impact of treatment timing and its effect on hematoma volume. Results from a CT substudy of almost 3000 participants revealed no significant effect on either relative or absolute hematoma growth in the initial 24 hours between intensive and guideline treatment approaches. However, when intensive BP lowering began within three hours of symptom onset, functional recovery improved, and hematoma growth was reduced in almost a quarter of patients.

Expert Insights

In an accompanying editorial, David J. Werring noted the importance of considering the specific pathophysiology of ICH, where hematoma expansion plays a major role in the first few hours. He suggested that intensive BP lowering could be a useful intervention to improve outcomes for individuals with acute ICH, emphasizing the need for further research.

The analysis was funded by a multitude of organizations worldwide, and the investigators disclosed various financial relationships. Despite the limitations of the study, the results underscore the critical importance of early intervention in managing ICH. More research is warranted, but the current findings strongly support the idea that, as Werring concluded, “time is brain” for those with ICH.