The timing of intensive blood pressure (BP) control may influence outcomes after intracerebral hemorrhage (ICH) surgery. A post hoc secondary analysis of the INTERACT3 trial, published in Stroke, evaluated whether earlier achievement of systolic BP <140 mm Hg was associated with outcomes in patients undergoing surgical hematoma evacuation. INTERACT3 was a pragmatic, international, multicenter, stepped-wedge cluster-randomized trial with blinded endpoint assessment.

Among 7036 enrolled patients across 121 hospitals, 1506 who underwent surgical hematoma evacuation were included. Patients were categorized by time from hospital arrival to achieving target BP (≤2 hours vs >2 hours). Adjusted analyses accounted for age, sex, treatment type, and admission Glasgow Coma Scale.

Six-month mortality was not significantly different between groups (adjusted hazard ratio [HR], 0.81; 95% CI, 0.63–1.04; P=0.09). Early BP achievement was associated with lower odds of death or disability (adjusted odds ratio [OR], 0.71; 95% CI, 0.56–0.90; P=0.01) and a favorable shift in modified Rankin Scale scores (adjusted common OR, 0.73; 95% CI, 0.60–0.89; P<0.01).

Early BP control was also associated with fewer serious adverse events (adjusted OR, 0.73; 95% CI, 0.57–0.94; P=0.02). Health-related quality-of-life outcomes favored the early group across EuroQol 5-Dimension 3-Level (EQ-5D-3L) domains, including mobility (OR, 0.76; 95% CI, 0.60–0.97; P=0.03), pain/discomfort (OR, 0.72; 95% CI, 0.54–0.95; P=0.02), and usual activities (OR, 0.79; 95% CI, 0.62–1.00; P=0.05), along with higher visual analog scale scores (mean difference, 0.08; 95% CI, 0.002–0.17; P=0.04) and health utility index (mean difference, 0.05; 95% CI, 0.02–0.09; P<0.01).

These findings indicate that earlier achievement of target BP was associated with improved functional and quality-of-life outcomes and fewer adverse events, without a significant difference in mortality. The results support further evaluation of early perioperative BP control in prospective studies.