Arima Hisatomi, Heeley Emma, Delcourt Candice, Hirakawa Yoichiro, Wang Xia, Woodward Mark, Robinson Thompson, Stapf Christian, Parsons Mark, Lavados Pablo M, Huang Yining, Wang Jiguang, Chalmers John, Anderson Craig S
From The George Institute for Global Health (H.A., E.H., C.D., Y.H., X.W., M.W., J.C., C.S.A.), University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease (T.R.), University of Leicester, UK; Department of Neurology (C.S.), APHP, Hôpital Lariboisière and DHU NeuroVasc Paris, Sorbonne, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Department of Neurology (M.P.), John Hunter Hospital, University of Newcastle, Australia; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.M.L.), Universidad de Chile, Santiago; Department of Neurology (Y.H.), Peking University First Hospital, Beijing; and The Shanghai Institute of Hypertension (J.W.), Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China.
Neurology. 2015 Feb 3;84(5):464-71. doi: 10.1212/WNL.0000000000001205. Epub 2014 Dec 31.
To investigate the effects of intensive blood pressure (BP) lowering according to baseline BP levels and optimal achieved BP levels in patients with acute intracerebral hemorrhage (ICH).
INTERACT2 was an open, blinded endpoint, randomized controlled trial in 2,839 patients with ICH within 6 hours of onset and elevated systolic BP (SBP) (150-220 mm Hg) who were allocated to receive intensive (target SBP <140 mm Hg within 1 hour, with lower limit of 130 mm Hg for treatment cessation) or guideline-recommended (target SBP <180 mm Hg) BP-lowering treatment. Outcome was physical function across all 7 levels of the modified Rankin Scale at 90 days.
Analysis of the randomized comparisons showed that intensive BP lowering produced comparable benefits on physical function at 90 days in 5 subgroups defined by baseline SBP of <160, 160-169, 170-179, 180-189, and ≥190 mm Hg (p homogeneity = 0.790). Analyses of achieved BP showed linear increases in the risk of physical dysfunction for achieved SBP above 130 mm Hg for both hyperacute (1-24 hours) and acute (2-7 days) phases while modest increases were also observed for achieved SBP below 130 mm Hg.
Intensive BP lowering appears beneficial across a wide range of baseline SBP levels, and target SBP level of 130-139 mm Hg is likely to provide maximum benefit in acute ICH.
This study provides Class I evidence that the effect of intensive BP lowering on physical function is not influenced by baseline BP.
根据基线血压水平和急性脑出血（ICH）患者达到的最佳血压水平，研究强化降压的效果。
INTERACT2是一项开放、终点设盲的随机对照试验，纳入2839例发病6小时内且收缩压（SBP）升高（150 - 220 mmHg）的ICH患者，将其随机分配接受强化降压治疗（1小时内目标SBP < 140 mmHg，治疗终止下限为130 mmHg）或指南推荐的降压治疗（目标SBP < 180 mmHg）。结局指标为90天时改良Rankin量表所有7个等级的身体功能。
随机对照分析显示，在根据基线SBP分为<160、160 - 169、170 - 179、180 - 189和≥190 mmHg的5个亚组中，强化降压在90天时对身体功能产生的益处相当（p同质性 = 0.790）。对达到的血压进行分析显示，超急性期（1 - 24小时）和急性期（2 - 7天）达到的SBP高于130 mmHg时，身体功能障碍风险呈线性增加，而达到的SBP低于130 mmHg时也观察到适度增加。
强化降压在广泛的基线SBP水平范围内似乎有益，目标SBP水平为130 - 139 mmHg可能为急性ICH提供最大益处。
本研究提供I级证据，表明强化降压对身体功能的影响不受基线血压影响。
