Effects of Blood Pressure Lowering by Hematoma Location in Acute Intracerebral Hemorrhage.
Xinwen Ren, Xiaoying Chen, Xin Hu et al.
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In 30 seconds
This pooled individual-patient analysis of five international randomised controlled trials examined whether hematoma location modifies the effect of early intensive blood pressure lowering in acute intracerebral hemorrhage. Among 11,288 patients, 81.5% had deep, 10.1% lobar and 8.4% infratentorial hemorrhage. The treatment effect on death or disability differed by location (p for interaction = 0.033); a clear benefit was observed only in deep hemorrhage, where the adjusted odds ratio was 0.81 (95% CI 0.74-0.89; p < 0.001).
Key findings
- The pooled analysis included 11,288 patients: 9,202 with deep, 1,141 with lobar and 945 with infratentorial hemorrhage.
- Treatment effect on death or disability varied by hematoma location (p for interaction = 0.033).
- In deep hemorrhage, intensive blood pressure lowering was associated with lower odds of death or disability (adjusted odds ratio 0.81, 95% CI 0.74-0.89; p < 0.001); a clear benefit was not seen in other locations.
Why it matters
The findings suggest that hematoma location may be relevant when interpreting evidence for early intensive blood pressure lowering after intracerebral hemorrhage. The observed difference in treatment effect highlights that overall trial results may not apply uniformly across anatomical subgroups, while the pooled analysis does not establish that location alone should determine treatment.
What to keep in mind
This is a pooled subgroup analysis of trial data; the reported treatment-effect difference by location does not establish benefit in every patient within the deep-hemorrhage subgroup.