There were no significant differences between the two treatment approaches in terms of neurologic deterioration, expansion of the ICH, ischemic stroke, cardiovascular events, or severe symptomatic hypotension, she noted.
The ongoing ATACH II (Antihypertensive Treatment of Acute Cerebral Hemorrhage) trial should hopefully shed more light on the benefit of early blood pressure lowering after ICH onset. ATACH II has similar blood pressure–lowering targets and primary and secondary endpoints as INTERACT2. A key difference, however, is that nicardipine is being used as the sole blood pressure–lowering agent. Results should be available in 2016.
Dr. Philip Bath, professor of stroke medicine and chair of the division of stroke at the University of Nottingham, England, who chaired the session in which the INTERACT2 findings were revealed, said that it is still too early to change the guidelines, particularly in view of the fact that several other trials are also ongoing. These include the ENOS (Efficacy of Nitric Oxide on Stroke) trial, of which he is the principal investigator.
"I think randomized data that are near are probably more important than guidelines, so I would always favor more data. It’s not as if we are going to have to wait a very long time; they will be there in the next year or two," Dr. Bath argued.
Study investigator Dr. Christian Stapf, professor of neurology at Université Diderot–Sorbonne Paris Cité, France, commented that, as a clinical scientist, he agreed that more data would be preferable before changing practice.
As a clinician, however, he said, "At this stage I don’t see the risk of any harm. I have no reason not to do it, and if anything it will only help."
Dr. Anderson further commented at a press briefing: "We have presented, for the first time, a strategy that can improve recovery from ICH, the most devastating type of stroke." He emphasized that it was rapid and intensive blood pressure lowering, rather than the use of any specific treatment, that was important in the trial.
This is very good news for the stroke community, Dr. Anderson argued. "We would expect guidelines to change and clinical practice to change as a result of this strategy."
The National Health and Medical Research Council of Australia funded INTERACT2, which was an investigator-led trial. The experts cited in this report had no relevant disclosures.