Functional Outcomes After Intensive Blood Pressure Reduction in Deep and Lobar Intracerebral Hemorrhage

BACKGROUND AND OBJECTIVES: Intensive blood pressure (BP) reduction may reduce the risk of poor functional outcomes in patients with acute intracerebral hemorrhage (ICH). Whether these potential benefits apply similarly to lobar and deep ICH, 2 biologically and clinically distinct subtypes, remains uncertain. We tested the hypothesis that intensive BP reduction has differential effects on functional outcomes based on ICH location. METHODS: We performed a stepwise meta-analysis, stratified by ICH location, of 3 landmark randomized clinical trials of intensive BP reduction: Acute Cerebral Hemorrhage (ATACH-2), Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 (INTERACT2), and INTERACT3. Step 1 pooled ATACH-2 and INTERACT2 (3-month outcomes; intensive BP lowering only). Step 2 added INTERACT3 (6-month outcomes; care bundle protocol with intensive BP lowering plus glucose management, antipyresis, and anticoagulant reversal). For ATACH-2, we used pooled results from individual patient data (adjusted for age, Glasgow Coma Scale score, and presence of intraventricular hemorrhage), whereas for INTERACT2 and INTERACT3, we used their pooled, publicly available results. Our exposure of interest contrasted intensive systolic BP targets