To determine whether intensive blood pressure (BP) treatment reduces hematoma expansion and improves outcomes in deep ICH, and whether this effect is modified by specific deep location (thalamic versus basal ganglia).

N/A

We performed a secondary analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage-2 (ATACH-2) trial in subjects with supratentorial deep ICH to determine whether intensive BP treatment is associated with hematoma expansion (> 33% or > 6mL) and 90-day modified Rankin Scale (mRS).

Of 1000 ATACH-2 subjects, 870 (87%) had deep ICH, of whom 780 (90%) had complete neuroimaging data. Intensive treatment was associated with a lower risk of hematoma expansion (unadjusted OR 0.62, 95%CI 0.43-0.87, p=0.006; adjusted OR 0.61, 95%CI 0.42-0.88, p=0.009). This association was modified by the specific location of the ICH (interaction p=0.02), with less hematoma expansion with intensive treatment among basal ganglia (2.6 mL [SD 7 mL] vs 4.6 mL [SD 9 mL], p=0.02) but not thalamic ICH (3.5 mL [SD 10 mL] vs 3.2 mL [SD 9 mL], p=0.74). Intensive treatment was not associated with improved mRS distribution (p>0.2).

Compared to standard treatment, intensive treatment was associated with less hematoma expansion in deep ICH, specifically among basal ganglia hemorrhages.