2013Stroke2839 patients

INTERACT2

Therapy group: Blood pressure control · Therapy: Intensive BP lowering (<140) vs guideline (<180) in intracerebral hemorrhage

In acute intracerebral hemorrhage, rapid systolic lowering below 140 was safe and modestly improved functional outcomes, without significantly reducing death or major disability.

Published in N Engl J Med (2013)

Question: Does rapid, intensive blood pressure lowering in patients with acute intracerebral hemorrhage improve functional outcome?
Design: International, randomized, open-label trial of 2839 patients, with outcome assessed at 90 days.
Population: Patients with spontaneous intracerebral hemorrhage within the previous 6 hours and elevated systolic blood pressure.
Intervention: Intensive antihypertensive treatment targeting a systolic blood pressure <140 mm Hg within 1 hour, using agents chosen by the treating physician.
Control: Guideline-recommended treatment with a systolic target <180 mm Hg, also using agents chosen by the physician.
Primary outcome: Death or major disability, defined as a modified Rankin scale score of 3 to 6 at 90 days.
Results: The primary outcome occurred in 719 of 1382 patients (52.0%) with intensive treatment versus 785 of 1412 (55.6%) with guideline-recommended treatment (OR 0.87; 95% CI 0.75 to 1.01; P=0.06). The ordinal analysis of modified Rankin scores showed lower disability with intensive treatment (OR 0.87; 95% CI 0.77 to 1.00; P=0.04).
Safety: Mortality was 11.9% with intensive treatment and 12.0% with guideline-recommended treatment; nonfatal serious adverse events occurred in 23.3% and 23.6%, respectively.
Conclusion: Intensive blood pressure lowering did not significantly reduce the primary outcome of death or major disability, although the ordinal analysis suggested better functional outcomes.
Why it matters: It provided evidence that early, intensive blood pressure lowering in intracerebral hemorrhage is safe and may improve functional recovery, shaping acute management of these patients.

Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.

Generated on October 15, 2026

Sources

Original publication on PubMed (PMID 23713578) ↗Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage.
Journal article (DOI) ↗
ClinicalTrials.gov record (NCT00716079) ↗

Videos explaining it

INTERACT2--BP Variability Is an Important Determinant of Outcome in Acute ICH

AHA · AHAScience ↗6:47Video page

Source: AHAScience · YouTube
Date: 13 Feb 2014
Audio: English
Subtitles: MultilingualYouTube
Audio transl.: None

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