Effects of Blood Pressure Lowering by Hematoma Location in Acute Intracerebral Hemorrhage.

However, whether the effect varies by hematoma location is uncertain.

然而，这种效果是否会因血肿位置的不同而有所变化尚不明确。

We aimed to determine the heterogeneity of the treatment effect of intensive BP lowering on functional outcome by hematoma location.

我们的目标是确定通过血肿位置对功能结果的影响在积极降低血压治疗效果上的异质性。

Methods

We conducted a pooled analysis of individual patient-level data (IPD) from all 4 Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials (INTERACT) and the second Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH-II) trial, which were international, randomized, open, blinded end point assessed, controlled trials that investigated the effectiveness of early intensive BP control in acute ICH.

我们对所有4个急性脑出血降压研究（INTERACT）和第二个急性脑出血降压治疗（ATACH-II）试验的个体患者数据（IPD）进行了汇总分析，这些试验是国际性的、随机的、开放的、盲终点评估的对照试验，研究了早期积极血压控制在急性脑出血中的有效性。

ICH location was classified as lobar or deep hemisphere or infratentorial. The primary outcome was death or disability (modified Rankin Scale scores 3-6) at 90 days or 6 months (for INTERACT3).

ICH位置被分类为叶状或深半球或幕下。主要结果是在90天或6个月（对于INTERACT3）时的死亡或残疾（改良Rankin量表评分3-6）。

The heterogeneity of the treatment effect of intensive BP lowering on the primary outcome by ICH location was estimated using generalized linear mixed models with trial as a random effect and adjustment for prespecified clinical covariates and an interaction term of "treatment-by-location."

使用广义线性混合模型估计了ICH位置对主要结果的影响的异质性，其中试验作为随机效应，并对预先指定的临床协变量和“治疗-位置”交互项进行了调整。

Results

Among 11,288 patients (mean age 62.5 years [SD 12.7]; 4,056 [35.9%] women), 1,141 (10.1%) had lobar ICH, 9,202 (81.5%) had deep ICH and 945 (8.4%) had infratentorial ICH.

在11,288名患者（平均年龄62.5岁[标准差12.7]；4,056名[35.9%]女性）中，1,141名（10.1%）患有叶状ICH，9,202名（81.5%）患有深部ICH，945名（8.4%）患有幕下ICH。

Compared with deep or infratentorial ICH, lobar ICH occurred in older patients, was less often associated with intraventricular hemorrhage, and had larger hematoma volumes (all p < 0.001).

与深部或幕下ICH相比，叶状ICH发生在年龄较大的患者中，与脑室内出血的关联较少，且血肿体积较大（所有p < 0.001）。

The effect of intensive BP lowering on the primary outcome of death or disability differed by ICH location (p for interaction = 0.033).

强化降压对死亡或残疾主要结果的影响因脑内出血(ICH)部位而异（交互作用p值=0.033）。

A clear benefit was only seen in deep ICH (adjusted odds ratio 0.81, 95% CI 0.74-0.89; p < 0.001).

仅在深部ICH中看到了明确的益处（调整后的优势比为0.81，95%置信区间为0.74-0.89；p<0.001）。

Discussion

Hematoma location modifies the treatment effect of intensive BP lowering on functional outcome after ICH, with the benefit observed only in deep ICH.

血肿位置改变了强化降压对ICH后功能结果的治疗效果，仅在深部ICH中观察到益处。

trial_registration_information

These trials are registered at ClinicalTrials.gov (INTERACT1 NCT00226096; INTERACT2 NCT00716079; INTERACT3 NCT03209258; INTERACT4 NCT03790800; and ATACH-II NCT01176565).

这些试验已在ClinicalTrials.gov注册（INTERACT1 NCT00226096；INTERACT2 NCT00716079；INTERACT3 NCT03209258；INTERACT4 NCT03790800；和ATACH-II NCT01176565）。