Effects of Blood Pressure Lowering by Hematoma Location in Acute Intracerebral Hemorrhage

Early intensive blood pressure (BP) lowering is now recognized as an effective approach to improve outcome after acute intracerebral hemorrhage (ICH). However, whether the effect varies by hematoma location is uncertain. We aimed to determine the heterogeneity of the treatment effect of intensive BP lowering on functional outcome by hematoma location.

We conducted a pooled analysis of individual patient-level data (IPD) from all 4 Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials (INTERACT) and the second Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH-II) trial, which were international, randomized, open, blinded end point assessed, controlled trials that investigated the effectiveness of early intensive BP control in acute ICH. ICH location was classified as lobar or deep hemisphere or infratentorial. The primary outcome was death or disability (modified Rankin Scale scores 3-6) at 90 days or 6 months (for INTERACT3). The heterogeneity of the treatment effect of intensive BP lowering on the primary outcome by ICH location was estimated using generalized linear mixed models with trial as a random effect and adjustment for prespecified clinical covariates and an interaction term of "treatment-by-location."