Background: Intensive lowering of blood pressure in the hyperacute phase after intracerebral haemorrhage may improve outcome (as observed in the INTERACT-2 trial) or have no effect (ATACH-2). Clinical guidelines recommend BP lowering.
Methods: We investigated the relationship between BP, and BP lowering treatment on functional outcome, death and serious adverse events at day 90. Statistical models were adjusted for baseline characteristics.
Results: As at 18th July 2016, 1161 (71.4%) of patients were on BP lowering treatment by day 2; these patients were younger (mean (SD): 67.7 (13.9) vs 71.9 (12.9) years, p-value<0.0001), more likely to be male (660/1161 (56.9%) vs 241/466 (51.7%), p-value=0.0598) and had lower NIHSS at baseline (12.5 (7.2) vs 14.2 (8.0), p-value<0.0001). Patients on BP lowering were found to have significantly better mRS and Barthel Index by day 90 (p-values: 0.0171, 0.0482, respectively) as compared to those not on treatment, and fewer of these patients died or suffered an SAE (p-values: 0.0074, 0.0002, respectively). However, there was no relationship between systolic BP levels (<140 vs >= 140 mmHg) on day 2, and outcome at day 90.
Conclusion: Early BP lowering is associated with improved functional outcome, and fewer deaths and SAEs, at day 90. Those achieving a BP target of <140mmHg by day 2 did not have a better outcome, suggesting that the optimal BP target may need more investigation.