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Intravenous nicardipine dosing for blood pressure lowering in acute intracerebral hemorrhage: the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-Intracerebral Hemorrhage study.
J Stroke Cerebrovasc Dis. 2014 Nov-Dec; 23(10):2780-2787.JS

Abstract

BACKGROUND

Intravenous nicardipine is commonly used to reduce elevated blood pressure in acute intracerebral hemorrhage (ICH). We determined factors associated with nicardipine dosing and the association of dose with clinical outcomes in hyperacute ICH.

METHODS

Hyperacute (<3 hours from onset) ICH patients with initial systolic blood pressure (SBP) greater than 180 mm Hg were included. All patients initially received 5 mg/hour of intravenous nicardipine. The dose was adjusted to maintain SBP between 120 and 160 mm Hg. Associations of maximum hourly and total doses with early neurologic deterioration (END), hematoma expansion (>33%), and modified Rankin Scale score 4-6 at 3 months were assessed.

RESULTS

Two hundred six patients (81 women, 65.8 ± 11.8 years) were studied. Initial SBP was 201.9 ± 15.9 mm Hg. Maximum and total nicardipine doses were 9.1 ± 4.2 mg/hour and 123.7 ± 100.2 mg/day, respectively. Multivariate analyses revealed that men (standardized regression coefficient [β] = .20, P = .0030 for maximum dose; β = .25, P = .0002 for total dose), age (β = -.28, P = .0002; β = -.25, P = .0005), and initial SBP (β = .19, P = .0018; β = .18, P = .0021) were independently associated with both maximum and total doses. Body weight (β = .20, P = .0084) was independently associated with total dose. After multivariate adjustment, maximum dose (per 1 mg/hour; odds ratio [OR], 1.25; 95% confidence interval [CI], 1.09-1.45) was independently, and total dose (per 10 mg/day; OR, 1.06; 95% CI, .998-1.132) tended to be independently, associated with END. Nicardipine dose was not associated with hematoma expansion or 3-month outcome.

CONCLUSIONS

Nicardipine dose is roughly predictable with sex, age, body weight, and initial SBP in acute ICH. The maximum dose was associated with neurologic deterioration.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Koga M
Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan. Electronic address: koga@ncvc.go.jp.
Arihiro S
Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan.
Hasegawa Y
Department of Neurology, St Marianna University School of Medicine, Kawasaki, Japan.
Shiokawa Y
Departments of Neurosurgery and Stroke Center, Kyorin University School of Medicine, Mitaka, Japan.
Okada Y
Department of Cerebrovascular Disease, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Kimura K
Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan.
Furui E
Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan.
Nakagawara J
Department of Neurosurgery and Stroke Center, Nakamura Memorial Hospital, Sapporo, Japan.
Yamagami H
Department of Neurology, Stroke Center, Kobe City General Hospital, Kobe, Japan.
Kario K
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.
Okuda S
Department of Neurology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
Tokunaga K
Department of Cerebrovascular Medicine, Japan.
Takizawa H
Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
Takasugi J
Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
Sato S
Department of Cerebrovascular Medicine, Japan.
Nagatsuka K
Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
Minematsu K
Department of Cerebrovascular Medicine, Japan.
Toyoda K
Department of Cerebrovascular Medicine, Japan.
Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI) Study Investigators
No affiliation info available

MeSH

Acute DiseaseAge FactorsAgedAntihypertensive AgentsBlood PressureBody WeightDrug Dosage CalculationsFemaleHumansInfusions, IntravenousIntracranial Hemorrhage, HypertensiveJapanLinear ModelsMaleMiddle AgedMultivariate AnalysisNicardipineOdds RatioProspective StudiesSex FactorsTime FactorsTreatment OutcomeVasodilator Agents

Pub Type(s)

Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25314943

Citation

Koga, Masatoshi, et al. "Intravenous Nicardipine Dosing for Blood Pressure Lowering in Acute Intracerebral Hemorrhage: the Stroke Acute Management With Urgent Risk-factor Assessment and Improvement-Intracerebral Hemorrhage Study." Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, vol. 23, no. 10, 2014, pp. 2780-2787.
Koga M, Arihiro S, Hasegawa Y, et al. Intravenous nicardipine dosing for blood pressure lowering in acute intracerebral hemorrhage: the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-Intracerebral Hemorrhage study. J Stroke Cerebrovasc Dis. 2014;23(10):2780-2787.
Koga, M., Arihiro, S., Hasegawa, Y., Shiokawa, Y., Okada, Y., Kimura, K., Furui, E., Nakagawara, J., Yamagami, H., Kario, K., Okuda, S., Tokunaga, K., Takizawa, H., Takasugi, J., Sato, S., Nagatsuka, K., Minematsu, K., & Toyoda, K. (2014). Intravenous nicardipine dosing for blood pressure lowering in acute intracerebral hemorrhage: the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-Intracerebral Hemorrhage study. Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, 23(10), 2780-2787. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.06.029
Koga M, et al. Intravenous Nicardipine Dosing for Blood Pressure Lowering in Acute Intracerebral Hemorrhage: the Stroke Acute Management With Urgent Risk-factor Assessment and Improvement-Intracerebral Hemorrhage Study. J Stroke Cerebrovasc Dis. 2014 Nov-Dec;23(10):2780-2787. PubMed PMID: 25314943.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intravenous nicardipine dosing for blood pressure lowering in acute intracerebral hemorrhage: the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-Intracerebral Hemorrhage study. AU - Koga,Masatoshi, AU - Arihiro,Shoji, AU - Hasegawa,Yasuhiro, AU - Shiokawa,Yoshiaki, AU - Okada,Yasushi, AU - Kimura,Kazumi, AU - Furui,Eisuke, AU - Nakagawara,Jyoji, AU - Yamagami,Hiroshi, AU - Kario,Kazuomi, AU - Okuda,Satoshi, AU - Tokunaga,Keisuke, AU - Takizawa,Hotake, AU - Takasugi,Junji, AU - Sato,Shoichiro, AU - Nagatsuka,Kazuyuki, AU - Minematsu,Kazuo, AU - Toyoda,Kazunori, AU - ,, Y1 - 2014/10/12/ PY - 2014/06/20/received PY - 2014/06/30/accepted PY - 2014/10/16/entrez PY - 2014/10/16/pubmed PY - 2015/11/17/medline KW - Acute stroke KW - blood pressure KW - calcium-channel blocker KW - intracerebral hemorrhage KW - nicardipine SP - 2780 EP - 2787 JF - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association JO - J Stroke Cerebrovasc Dis VL - 23 IS - 10 N2 - BACKGROUND: Intravenous nicardipine is commonly used to reduce elevated blood pressure in acute intracerebral hemorrhage (ICH). We determined factors associated with nicardipine dosing and the association of dose with clinical outcomes in hyperacute ICH. METHODS: Hyperacute (<3 hours from onset) ICH patients with initial systolic blood pressure (SBP) greater than 180 mm Hg were included. All patients initially received 5 mg/hour of intravenous nicardipine. The dose was adjusted to maintain SBP between 120 and 160 mm Hg. Associations of maximum hourly and total doses with early neurologic deterioration (END), hematoma expansion (>33%), and modified Rankin Scale score 4-6 at 3 months were assessed. RESULTS: Two hundred six patients (81 women, 65.8 ± 11.8 years) were studied. Initial SBP was 201.9 ± 15.9 mm Hg. Maximum and total nicardipine doses were 9.1 ± 4.2 mg/hour and 123.7 ± 100.2 mg/day, respectively. Multivariate analyses revealed that men (standardized regression coefficient [β] = .20, P = .0030 for maximum dose; β = .25, P = .0002 for total dose), age (β = -.28, P = .0002; β = -.25, P = .0005), and initial SBP (β = .19, P = .0018; β = .18, P = .0021) were independently associated with both maximum and total doses. Body weight (β = .20, P = .0084) was independently associated with total dose. After multivariate adjustment, maximum dose (per 1 mg/hour; odds ratio [OR], 1.25; 95% confidence interval [CI], 1.09-1.45) was independently, and total dose (per 10 mg/day; OR, 1.06; 95% CI, .998-1.132) tended to be independently, associated with END. Nicardipine dose was not associated with hematoma expansion or 3-month outcome. CONCLUSIONS: Nicardipine dose is roughly predictable with sex, age, body weight, and initial SBP in acute ICH. The maximum dose was associated with neurologic deterioration. SN - 1532-8511 UR - https://www.unboundmedicine.com/medline/citation/25314943/Intravenous_nicardipine_dosing_for_blood_pressure_lowering_in_acute_intracerebral_hemorrhage:_the_Stroke_Acute_Management_with_Urgent_Risk_factor_Assessment_and_Improvement_Intracerebral_Hemorrhage_study_ DB - PRIME DP - Unbound Medicine ER -
Grapherence [↓3]

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