Implications of INTERACT2 and other clinical trials: Blood pressure management in acute intracerebral hemorrhage

INTERACT2 provides important new evidence of efficacy and safety of early intensive BP lowering in ICH. These data will be further supplemented with results of the ATACH II study and in a meta-analysis of all such trials being undertaken as part of a new wave of analyses under the auspices of the Blood pressure in Acute Stroke Collaboration.40 We argue that a key next step is to assess the effectiveness of this intervention in routine clinical practice in which the contextspecific systems for delivering care are incorporated into the intervention design and in turn are also tested. To effectively reduce the challenges in implementation of complex interventions that require system changes in clinical practice, data must be acquired on cost-effectiveness and the identification of barriers to such implementation to enhance the application of early targeted BP lowering as a standard of care in ICH.