Early blood pressure reduction to improve stroke outcomes
Early and intensive lowering of high blood pressure shows promising effects in stroke patients, according to results of a new stroke study by The George Institute for International Health.
Initial results of the first large-scale investigation into managing raised blood pressure after intracerebral haemorrhage (stroke) demonstrates that rapid blood pressure lowering is well tolerated and appears to reduce the amount of bleeding in the brain, indicating a that such treatment could reduce the risk of death and disability in stroke patients.
"These results show that drug treatment to lower elevated blood pressure can be given quickly and safely to patients with intracranial haemorrhage," said Professor Craig Anderson from The George Institute, who outlined results today at the American Heart Association’s International Stroke Conference in New Orleans. "Furthermore, this treatment appears to limit bleeding in the brain in this type of stroke, which may improve chances of recovery for patients."
Intracerebral haemorrhage (ICH) is the most serious type of stroke that results from rupture of a blood vessel within the brain. This is often the result of high blood pressure and affects over one million of people around the world each year. Over one third of patients die early after the onset of ICH and most survivors are left permanently disabled. The aims of the vanguard, or pilot study, were to determine the feasibility and safety of rapid lowering of elevated blood pressure to more ‘normal’ levels after the onset of intracerebral haemorrhage, and also test whether the treatment reduces the amount of bleeding in the brain.
The results challenge the current international guidelines for the management of blood pressure in stroke, which tend to indicate that high blood pressure is dangerous but are uncertain about either the level at which to either commence or cease such treatment. Professor Anderson explained that currently there is wide variation in the use of blood pressure lowering as acute treatment for stroke around the world.
The INTERACT (The INTEnsive blood pressure Reduction in Acute Cerebral haemorrhage Trial) vanguard phase recruited 404 patients from 44 hospitals in Australia, China and South Korea from November 2005 to April 2007. Patients who presented within six hours of onset of intracerebral haemorrhage and with acute hypertension, were randomised to receive either a treatment strategy of rapid blood pressure lowering or the more conservative, American Heart Association guideline-based blood pressure lowering. Patients were followed-up to assess their response to treatment, degree of recovery and changes in brain scans.
"Despite the magnitude of the burden imposed by this disease, and the high cost to health services, there is no widely available treatment for the condition. However, early rapid blood pressure lowering shows considerable promise as a widely applicable, cost-effective therapy that can be readily incorporated into clinical practice," noted Professor Anderson.
Professor Anderson said that this hypothesis will be tested in a much larger, main phase to INTERACT in some 2,000 patients with intracerebral haemorrhage, commencing later this year. The study is funded by the National Health and Medical Research Council of Australia.
INTERACT_Vanguard_Media_Slides
INTERACT results of the vanguard phase abstract in CHINESE
INTERACT results of the vanguard phase abstract in ENGLISH
Media
For further information, please contact:
Emma Orpilla - Public Relations,
The George Institute for International Health
Tel: +612 9993 4500/ Mobile: +61410 411 983
Fax: +612 9993 4501/ email: eorpilla@george.org.au
Notes to Editor
- The George Institute for International Health is an internationally-recognised health research organisation, undertaking high impact research across a broad health landscape. It is a leader in clinical trials, health policy and capacity-building areas.
- INTERACT (Intensive blood pressure reduction in acute cerebral haemorrhage trial) is an international, multi-centre, randomised controlled trial involving patients with who present within six hours of acute intracerebral haemorrhage and with co-occurring high blood pressure to be recruited from Clinical Centres in China, Australia, Asia and Europe. The preliminary vanguard phase was undertaken in some 44 clinical sites,in Australia, Korea and China, the later mainly in hospitals in Beijing and Shanghai, during 2005-2007. The main phase in some 2000 patients to be recruited from 100 site around the world will commence later in 2008.
- The INTERACT study was funded by a grant from the National Health and Medical Research Council (NHMRC) of Australia. Professor Anderson holds an NHMRC Senior Research Fellowship and is employed by The George Institute for International Health who undertook this research independent of the NHMRC.
- The National Health & Medical Research Council of Australia is Australia's peak body for supporting health and medical research; for developing health advice for the Australian community, health professionals and governments; and for providing advice on ethical behaviour in health care and in the conduct of health and medical research.
- The study is internationally coordinated by the George Institute for International Health (Professor Craig Anderson, Principal Investigator) in collaboration with coordinating centres in Beijng (Professor Huang Yining, Peking University First Hospital) and Shanghai (Professor Wang Jiguang, Shanghai Institute of Hypertension).
- Professor Craig Anderson is Director of the Neurological and Mental Health Division at The George Institute. He is also Professor of Stroke Medicine and Clinical Neuroscience in the Faculty of Medicine at the University of Sydney and the Royal Prince Alfred Hospital. He is a member of several specialist societies, is an Editor for the Cochrane Stroke Group, and is the Immediate Past-President of the Stroke Society of Australasia.