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ESOC 2023 | Blood pressure management in intracerebral hemorrhage

Craig Anderson, PhD, from the University of New South Wales, Australia, shares an overview of current thinking regarding BP management given the findings from recent trials. One such study was INTERACT3 (NCT03209258), which incorporated early intensive blood pressure lowering (less than 140 mmHg within one hour) as part of a multifaceted care bundle. Previous findings from INTERACT2 (NCT00716079) did not show a significant reduction in death or severe disability with intensive BP lowering, compared to less intensive management, although an ordinal analysis of modified Rankin scores indicated improved functional outcomes. However, INTERACT3 included a larger patient sample, analyzed various parameters and demonstrated positive results. ATACH-2 (NCT01176565) utilized a different protocol with more rapid blood pressure reduction and a lower target (110-139 mmHg), but was stopped due to futility. When combined with other trials, the data suggests that reducing blood pressure to 140mmHg within an hour is safe and can improve clinical outcomes in patients with ICH. Prof Anderson further discusses the challenges of timing of blood pressure control, as most bleeding in ICH occurs within four hours. Further research is needed to determine how to achieve blood pressure control within the first few hours, such as in the ambulance or emergency department. This interview took place at The European Stroke Organisation Conference 2023 in Munich, Germany.

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Craig Anderson reports the following disclosures: I have received grant monies paid to my institution from the National Health and Medical Research Council (NHMRC) of Australia, the Medical Research Council (MRC) of the UK, Takeda, Penumbra, and Credit pharma. I have leadership positions as Editor-in-Chief of Cerebrovascular Diseases journal and am Vice-President of the World Stroke Organisation.