Low ambient temperature and intracerebral hemorrhage: The INTERACT2 study

Danni Zheng, Hisatomi Arima, Shoichiro Sato, Antonio Gasparrini, Emma Heeley, Candice Delcourt, Serigne Lo, Yining Huang, Jiguang Wang, Christian Stapf, Thompson Robinson, Pablo Lavados, John Chalmers, Craig S. Anderson, INTERACT2 Investigators

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15 Citations (Scopus)
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BackgroundRates of acute intracerebral hemorrhage (ICH) increase in winter months but the magnitude of risk is unknown.We aimed to quantify the association of ambient temperature with the risk of ICH in the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT2) participants on an hourly timescale. Methods INTERACT2 was an international, open, blinded endpoint, randomized controlled trial of patients with spontaneous ICH (<6h of onset) and elevated systolic blood pressure (SBP, 150-220 mmHg) assigned to intensive (target SBP <140 mmHg) or guideline-recommended (SBP <180 mmHg) BP treatment. We linked individual level hourly temperature to baseline data of 1997 participants, and performed case-crossover analyses using a distributed lag non-linear model with 24h lag period to assess the association of ambient temperature and risk of ICH. Results were presented as overall cumulative odds ratios (ORs) and 95%CI. Results Low ambient temperature (10°C) was associated with increased risks of ICH: overall cumulative OR was 1.37 (0.99-1.91) for 10°C, 1.92 (1.31-2.81) for 0°C, 3.13 (1.89-5.19) for-10°C, and 5.76 (2.30-14.42) for-20°C, as compared with a reference temperature of 20°C.There was no clear relation of low temperature beyond three hours after exposure. Results were consistent in sensitivity analyses. Conclusions Exposure to low ambient temperature within several hours increases the risk of ICH.

Original languageEnglish
Article numbere0149040
JournalPLoS One
Issue number2
Publication statusPublished - 9 Feb 2016

Bibliographical note

Copyright: © 2016 Zheng et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


  • low ambient temperature
  • INTERACT2 Study
  • intracerebral hemorrhage


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