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早期严格地治疗急性脑出血（ICH）病患的高血压是耐受性良好的，且显然可以减少血肿形成。根据美国中风协会（ASA）国际中风会议（ISC）2008最新科学研究结果，这项研究结果是来自于INTERACT（the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial）试验，结果显示，接受降血压药物严格控制血压，相较于没有接受降血压药物的控制组，可以下降22%的平均血肿形成。
除此之外，血肿形成的频率，以持续出血超过三分之一起始体积定义，严格控制血压组下降了36%。
来自澳洲新德里乔治国际健康机构的主要研究者Craig Anderson医师，他向ISC会议的记者表示，我们感觉这项治疗是可行的，这是安全且带有讯息的，我们将可以停止脑部出血，我们相信这项结果是可信的。
高血压是造成ICH的原因，且这在急性疾病是非常常见的；然而，Anderson医师表示，所有针对急性中风血压控制的治疗指引，包括ICH，都是根据非随机分派、观察性试验数据，因此，医师对于如何应付这种情况并不清楚。
【最严重的中风形式】
然而，他附带表示，我们所知道的是，血压每上升一些，特别是收缩压，与预后不佳是有关的，包括死亡与依赖性。
他指出，我们相信高血压会造成更多的出血且使脑部出血情况恶化，因此理论上，如果我们可以降低血压，我们可能可以终止脑部出血、或是达到控制。
他表示，ICH在世界各地每年大约影响了100万人，在美国大约有10万名病患。
Anderson医师表示，这是最严重的一种中风，在白人身上，这大概占10%的中风，但是对非裔美人、西班牙裔、或是亚裔，这大概占了20%~30%，在中国的部份区域，比例甚至高达50%。
他附带表示，这可能与高血压的盛行率越来越高，或是该族群其他未知的因素有关。
这项研究收纳了404位病患，来自澳洲、中国与韩国的44家医院，从2005年的11月到2007年的4月之间进行；所有的受试者都罹患由电脑断层确认的急性ICH，且收缩压都介于150至220 mmHg之间。
这些病患被随机分派接受以常用静脉注射降血压药物，根据治疗计划进行严格血压控制，收缩压降低至140 mmHg以下，或是将血压控制在根据美国心脏医学会治疗指引的180 mmHg。
【脑部的血液较少】
每位病患在发生急性ICH后6个小时内都在有监视器的环境下开始治疗；再第一个小时后，严格控制组的平均动脉压比治疗指引调整组低了13.3 mmHg，换算起来，脑部约少了约2.5 ml或是半汤匙的血液。
在90天的后续追踪中，Anderson医师表示，并没有证据显示早期严格控制血压会增加不良事件的产生。
Anderson医师指出，一项大型、第三期称为INTERACT的临床研究将会收纳2,500位病患检验严格控制血压对ICH病患临床预后的影响，该研究即将在今年开始。
北卡莱纳州杜克大学杜汉校区的Larry Goldstein医师，他也是ASA的发言人，他向Medscape神经学与神经外科学表示，INTERACT试验提供改善病患预后的潜力。
他表示，目前，我们对于急性脑出血并没有已经证实有效的治疗，且因为缺乏研究数据，在这类病患的降血压治疗方面仍有争议；该研究的发现─严格地降低血压与脑血肿的形成较少有关，是激励我们的，我们希望这将改善病患的预后。
这项研究由澳洲国家健康与医疗研究局赞助。
Intensive BP Lowering Reduces Hematoma Growth in Intracerebral Hemorrhage
By
Medscape Medical News
Early intensive treatment for hypertension in patients with acute intracerebral hemorrhage (ICH) is well-tolerated and appears to reduce hematoma growth.
According to late-breaking science results presented here at the American Stroke Association (ASA) International Stroke Conference (ISC) 2008, findings from the pilot phase of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) showed that patients who received intensive antihypertensive therapy experienced a mean hematoma growth that was 22% lower than their counterparts who did not receive intensive blood pressure–lowering treatment.
Furthermore, frequency of substantial hematoma growth — defined by ongoing bleeding of more than one-third of initial volume — was 36% lower in the intensive group.
"We feel this treatment is feasible, it is safe, and there is a signal, which we believe is robust, that indicates we can arrest bleeding in the brain," principal investigator Craig Anderson, MD, PhD, from the George Institute for International Health, in Sydney, Australia, told reporters attending an ISC press conference.
High blood pressure is a cause of ICH, and it is also very common at the acute stage of illness. However, said Dr. Anderson, all of the guidelines for blood pressure control in acute stroke, including ICH, are based on nonrandomized, observational data. Therefore, he said doctors are uncertain of how to manage it.
Most Serious Form Of Stroke
However, he added, what is known is that every incremental increase in blood pressure, particularly systolic blood pressure, correlates with poorer outcomes, including death or dependence.
"We believe that high blood pressure causes extra bleeding and expansion of blood in the brain, so theoretically if we can bring the blood pressure down we might be able to arrest the bleeding in the brain or get it under control," he said.
ICH, he said, affects approximately 1 million people annually worldwide — with individuals in the United States accounting for 100,000 of these cases.
"It is the most serious form of stroke. In whites it probably accounts for 10% of stroke, but among African Americans, Hispanics, and Asians it accounts for about 20% to 30%, and in some places in China it accounts for half of all stroke," said Dr. Anderson.
"Presumably, this is related to the growing prevalence of hypertension and possibly other unknown factors in these populations," he added.
The study included 404 patients from 44 hospitals in Australia, China, and Korea recruited from November 2005 to April 2007. All subjects had an acute ICH confirmed by computerized tomography and elevated systolic blood pressure of 150 to 220 mm Hg.
Patients were randomly assigned to receive either intensive antihypertensive treatment based on a titrated protocol of routinely available intravenous agents to a target systolic blood pressure of 140 mm Hg or a less intensive treatment targeted to a systolic blood pressure of 180 mm Hg based on American Heart Association guidelines.
Less Blood in the Brain
Each patient began treatment in a monitored environment within 6 hours of suffering an acute ICH. After the first hour, systolic blood pressure was an average of 13.3 mm Hg lower in the intensive-therapy group than the guidelines-adjusted group. This equated to approximately 2.5 ml or half a teaspoon of less blood in the brain.
At 90-day follow-up, said Dr. Anderson, there was no evidence that early intensive blood pressure lowering increased the risk for adverse events.
A larger, phase 3 study of INTERACT that will include 2500 patients and examine the impact of intensive blood pressure lowering on clinical outcomes on ICH patients will be launched later this year, said Dr. Anderson.
Larry Goldstein, MD, from Duke University, in Durham, North Carolina, and a spokesperson for the ASA, told Medscape Neurology & Neurosurgery that the INTERACT study offers the potential for improved patient outcomes.
"Right now, we have no real proven therapies for acute intracerebral hemorrhage, and there has been controversy because of the lack of data as to the best way to manage blood pressure in these patients. The [study's] finding that intensive blood pressure lowering is associated with lower hematoma growth is encouraging and will hopefully lead to better outcomes," he said
The study was funded by the National Health and Medical Research Council of Australia.
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American Stroke Association International Stroke Conference 2008: Abstract LB 3. Presented February 22, 2008.