Functional Outcomes After Intensive Blood Pressure Reduction in Deep and Lobar Intracerebral Hemorrhage.

Whether these potential benefits apply similarly to lobar and deep ICH, 2 biologically and clinically distinct subtypes, remains uncertain.

这些潜在益处是否同样适用于叶状和深部ICH，这两种生物学和临床上不同的亚型，目前尚不确定。

We tested the hypothesis that intensive BP reduction has differential effects on functional outcomes based on ICH location.

我们测试了一个假设，即强化血压降低对基于脑出血（ICH）位置的功能结果有不同的影响。

Methods

We performed a stepwise meta-analysis, stratified by ICH location, of 3 landmark randomized clinical trials of intensive BP reduction: Acute Cerebral Hemorrhage (ATACH-2), Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 (INTERACT2), and INTERACT3.

我们对三项标志性的强化血压降低随机临床试验进行了按ICH位置分层的逐步荟萃分析：急性脑出血（ATACH-2）、急性脑出血强化血压降低试验2（INTERACT2）和INTERACT3。

Step 1 pooled ATACH-2 and INTERACT2 (3-month outcomes; intensive BP lowering only).

第一步合并了ATACH-2和INTERACT2研究 (3个月的结果；仅限于强化降压治疗).

Step 2 added INTERACT3 (6-month outcomes; care bundle protocol with intensive BP lowering plus glucose management, antipyresis, and anticoagulant reversal).

第二步加入了INTERACT3研究 (6个月的结果；包括强化降压、血糖管理、退热和抗凝逆转的综合护理协议).

For ATACH-2, we used pooled results from individual patient data (adjusted for age, Glasgow Coma Scale score, and presence of intraventricular hemorrhage), whereas for INTERACT2 and INTERACT3, we used their pooled, publicly available results.

在ATACH-2研究中，我们使用了个体患者数据的汇总结果（根据年龄、格拉斯哥昏迷评分和是否伴有脑室内出血进行了调整），而在INTERACT2和INTERACT3研究中，我们使用了它们的汇总、公开可用的结果。

Our exposure of interest contrasted intensive systolic BP targets <140 mm Hg vs standard care 140-180 mm Hg.

我们关注的暴露因素是强化收缩压目标<140毫米汞柱与标准护理140-180毫米汞柱的对比。

Our outcome of interest was poor functional outcome, defined as a modified Rankin Scale score of 4-6 in ATACH-2 and INTERACT3 and of 3-6 in INTERACT2.

我们关注的结果是功能预后不良，定义为ATACH-2和INTERACT3中改良Rankin量表评分为4-6，以及INTERACT2中评分为3-6。

Results

Step 1 included a total of 2,983 patients with deep and 537 patients with lobar ICH (mean age 63 y/o, 37% female).

第一步包括了总共2,983名深部和537名叶状脑出血患者（平均年龄63岁，女性占37%）。

Intensive BP reduction was not associated with a significant difference in poor functional outcome for either deep (odds ratio [OR] 0.89; 95% CI 0.40-1.98; I2 = 0%) or lobar (OR 0.92; 95% CI 0.73-1.17; I2 = 0%) ICH.

强化血压降低与深部（比值比[OR] 0.89; 95% 置信区间 0.40-1.98; I2 = 0%）或叶状（OR 0.92; 95% 置信区间 0.73-1.17; I2 = 0%）脑出血的不良功能结果之间没有显著差异。

Step 2 included a total of 7,917 patients with deep and 1,105 patients with lobar ICH (mean age 63 y/o, 37% female).

第二步包括了总共7917名深部和1105名叶状脑出血患者（平均年龄63岁，37%为女性）。

Similarly, intensive BP reduction was not associated with a significant difference in poor outcome in both deep (OR 0.82; 95% CI 0.57-1.18; I2 = 60%) and lobar (OR 0.97; 95% CI 0.76-1.24; I2 = 0%) ICH.

同样地，强化血压降低与深部（OR 0.82; 95% CI 0.57-1.18; I2 = 60%）和叶状（OR 0.97; 95% CI 0.76-1.24; I2 = 0%）脑出血不良结果之间没有显著差异。

Discussion

In this stepwise meta-analysisof 3 landmark ICH trials, intensive BP reduction did not demonstrate a significant benefit in either deep or lobar ICH.

在这项针对3项里程碑性脑出血试验的逐步荟萃分析中，强化血压降低在深部或叶状脑出血中均未显示出显著的益处。

Although our estimates did not reach statistical significance, the direction of effect in deep ICH and the substantial heterogeneity across trials, particularly with the inclusion of INTERACT3, limit firm conclusions.

尽管我们的估计没有达到统计学意义，但在深部脑内出血（ICH）中的效应方向以及试验间的显著异质性，特别是包括了INTERACT3研究后，限制了我们得出坚定结论的能力。

Given these uncertainties and the biological distinctions between deep and lobar ICH, future well-powered studies specifically designed to test whether intensive BP reduction has differential effects by hematoma location are warranted.

鉴于这些不确定性以及深部和叶状ICH之间的生物学差异，未来需要设计专门的、具有足够统计功效的研究，以测试强化血压降低是否对出血位置有不同的效果。