证据支持在急性脑出血中行早期强化降压治疗，但根据降压幅度患者是否有潜在益处和伤害一直未确定。因此多国学者对INTERACT2研究中受试者收缩压(SBP)降幅较大是否与其预后较佳有关进行了联合评估。

        INTERACT2研究是一项国际开放盲点随机对照试验，纳入自发脑出血(6小时内)和收缩压升高(150–220 mm Hg)的受试者，并将其分配至强化降压组(收缩压 目标<140 mm Hg)或指南推荐治疗组(SBP <180 mm Hg)。利用多变量逻辑回归模型分析随机化后3个时期(15–60分钟、1–24小时和2–7天)的血压降幅与90天转归不佳(死亡或严重残疾)的关系。

        结果显示，随机化后第一个小时SBP降幅较大与转归不佳风险较小有关：与最小降幅(<10 mm Hg)相比，中等程度的降幅(10–20 mm Hg)和大幅度降压(≥20 mm Hg)的比值比分别为0.80和0.65(P趋势<0.01)。在1–24小时和2–7天也可观察到SBP降幅与预后类似的相关性。在基线收缩压180 mm Hg以上或以下患者的关联分析中未发现异质性(P>0.30)。

        该研究表明，在脑出血1小时内实现最大收缩压降幅(≥20 mm Hg)并持续7天的高血压患者恢复得最理想。

        参考文献：Xia Wang, et al.HYPERTENSION AHA.114.05044Published online before print March 23, 2015,doi: 10.1161/HYPERTENSIONAHA.114.05044

Magnitude of Blood Pressure Reduction and Clinical Outcomes in Acute Intracerebral Hemorrhage
Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial Study

Abstract
Evidence supports early intensive blood pressure (BP) lowering in acute intracerebral hemorrhage, but uncertainty persists over whether potential benefits and harms vary according to the magnitude of BP reduction.
We aimed to determine whether larger systolic BP (SBP) reductions were associated with better outcomes in participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2).
INTERACT2 was an international, open, blinded end point, randomized controlled trial of patients with spontaneous intracerebral hemorrhage (<6 hours) and elevated SBP (150–220 mm Hg) assigned to intensive (target SBP <140 mm Hg) or guideline-recommended (SBP <180 mm Hg) treatment. Associations of BP reduction (baseline minus average of achieved SBP) during 3 time periods post randomization (15–60 minutes, 1–24 hours, and 2–7 days) on poor outcome (death or major disability) at 90 days were analyzed in multivariable logistic regression models with odds ratios and 95% confidence intervals.
Larger SBP reductions within the first hour after randomization were associated with lower risks of poor outcome: compared with minimal reduction (<10 mm Hg), odds ratios were 0.80 (95% confidence interval, 0.63–1.02) for moderate (10–20 mm Hg) and 0.65 (0.52–0.82) for large (≥20 mm Hg) reductions (P trend <0.01).
Similar associations were also observed for SBP reductions during 1 to 24 hours (P<0.01) and 2 to 7 days (P 0.02). No heterogeneity in associations for patients above or below baseline SBP 180 mm Hg was reported (P>0.30). Optimal recovery from intracerebral hemorrhage was observed in hypertensive patients who achieved the greatest SBP reductions (≥20 mm Hg) in the first hour and maintained for 7 days.