ESOC 2024 | Impact of timing of BP lowering on hematoma expansion in the INTERACT trials
Xia Wang, PhD, The George Institute for Global Health, Barangaroo, Australia, shares the findings of an individual patient data pooled analysis of the four INTERACT trials, which investigated the significance of timing of blood pressure (BP) lowering to mitigate hematoma expansion in intracerebral hemorrhage (ICH). The four INTERACT randomized, controlled trials tested the safety and efficacy of early intensive BP lowering in acute ICH. Evidence from over 2900 pooled participants showed that timing of systolic BP reduction had a substantial impact on the likelihood of hematoma growth. The earlier the treatment, the better the reduction in growth, up to a cut-off point of three hours. Dr Wang emphasizes the importance of these data in demonstrating that the ‘time is brain’ principle applies to ICH as well as ischemic stroke. This interview took place at the 10th European Stroke Organisation Conference (ESOC) 2024 in Basel, Switzerland.
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Transcript
My study is to combine the four INTERACT trial CT sub-studies. So the four INTERACT trials are all international, multicenter, randomized control trials to compare blood pressure lowering to less than 140mmhg compared with 180mmHg target. We recruited patients with acute intracerebral hemorrhage within 6 hours of onset. In recent trials of blood pressure lowering treatment in acute ICH including the individual patient data meta-analysis of BASC...
My study is to combine the four INTERACT trial CT sub-studies. So the four INTERACT trials are all international, multicenter, randomized control trials to compare blood pressure lowering to less than 140mmhg compared with 180mmHg target. We recruited patients with acute intracerebral hemorrhage within 6 hours of onset. In recent trials of blood pressure lowering treatment in acute ICH including the individual patient data meta-analysis of BASC. So in BASC we included about 16 trials, all the trials were in acute phase of ICH to compare the intensive blood pressure lowering treatment with best medical treatment. In this study we found blood pressure lowering treatment reduced hematoma growth at 24 hours, but it did not improve functional outcome so therefore in my current analysis we explore further. We focus on timing… so whether we are earlier to start the treatment and then patient will be benefitting more from the treatment. We found the results as we expected. Timing is a very important factor.
In this analysis we specifically focus on timing of the blood pressure lowering treatment so our hypothesis is that if we could start blood pressure lowering treatment earlier for the patients, we will be better to control hematoma growth at 24 hours. In our analysis, we focused on the time trend. We found that if we could start earlier of the blood pressure lowering treatment among patients with acute ICH, then it’s better to reduce hematoma growth at 24 hours. We also found that the optimal cut off point is at about 3 hours after ICH onset.
I want to emphasize the optimal time window of the 3 hours and what this means for clinical practice. In our patient cohort, it’s a randomized controlled trial so it includes the process of randomization. The median time from onset to randomization was about 3 hours and then it takes about 1 hour to lower the blood pressure to the target so typically it’s about 4 hours after stroke onset to reach the target but in real clinical practice it can be much shorter because randomization is not required. Our information for clinicians is to start the blood pressure lowering treatment as early as possible for patients with acute ICH.
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