Blood Pressure Reduction

INTERACT

Intensive blood pressure reduction in acute cerebral haemorrhage trial

Patients who had acute spontaneous ICH diagnosed by CT within 6 h of onset, elevated systolic BP (150-220 mm Hg), and no definite indication or contraindication to treatment were randomly assigned to early intensive lowering of BP (target systolic BP 140 mm Hg; n=203) or standard guideline-based management of BP (target systolic BP 180 mm Hg; n=201).

Early intensive BP-lowering treatment is clinically feasible, well tolerated, and seems to reduce haematoma growth in ICH

INTERACT 2

In patients with spontaneous intracerebral hemorrhage (ICH), does intensive blood pressure lowering (target systolic BP <140 mm Hg within 1 hour) reduce the risk of death or severe disability as compared to guideline-recommended treatment (target systolic BP <180 mm Hg)?

In patients with intracerebral hemorrhage intensive blood pressure lowering did not reduce the risk of death or severe disability

ATACH-II

Antihypertensive Treatment of Acute Cerebral Hemorrhage-II

intensive systolic blood pressure control with IV nicardipine to a target of 110 to 139 mm Hg improve disability or lower morality when compared to a standard target of 140 to 179 mm Hg

In patients with spontaneous intra-cranial hemorrhage with volume of <60 cm3 and a Glasgow Coma Scale (GCS) score of >4/15, there is no differences in mortality or morbidity in patients receiving intensive blood pressure control compared to standard blood pressure control

ATACH-II - Post Hoc Analysis The higher rate of neurological deterioration within 24 hours associated with intensive treatment in patients with intracerebral hemorrhage and initial systolic blood pressure of 220mmHg or more, without any benefit in reducing hematoma expansion at 24 hours or death or severe disability at 90 days,

warrants caution against generalization of recommendations for intensive systolic blood pressure reduction

A Secondary Analysis of the ATACH-2

Patients with intracerebral hemorrhage with vs without microbleeds have similar rates of hematoma expansion and death or disability at 3 months, without apparent differential response to intensive blood pressure lowering.

Clotting  Factor replacement

Factor VII

FAST

Efficacy and Safety of Recombinant Activated Factor VII for Acute Intracerebral Hemorrhage