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Nicardipine Reduces Blood Pressure Variability After Spontaneous Intracerebral Hemorrhage.
Neurocrit Care. 2019 02; 30(1):118-125.NC

Abstract

BACKGROUND

Blood pressure variability (BPV) is an independent predictor for early hematoma expansion, neurologic deterioration, and mortality. There are no studies on the effect of intravenous (IV) antihypertensive drugs on BPV. We sought to determine whether patients have more BPV with certain antihypertensive agents, in particular the effect of IV nicardipine.

METHODS

We conducted a single-center, retrospective chart review of individuals diagnosed with spontaneous intracerebral hemorrhage (ICH) receiving labetalol, hydralazine, and/or nicardipine within 24 h of hospital admission to assess the primary endpoint of BPV, defined as the standard deviation of systolic BP, with labetalol and/or hydralazine compared to nicardipine ± labetalol and/or hydralazine. Repeated measures linear regression was performed to compare BPV over 24 h between regimens, and Cox proportional hazards regression was used to compare the time to goal SBP between regimens.

RESULTS

Of the 1330 patients screened, 272 were included in our analysis; those included had a mean age of 69 years with 87.9% of Caucasian race. A total of 164 patients received IV bolus antihypertensives alone (labetalol, hydralazine or both), and 108 patients received IV nicardipine with or without additional IV boluses (labetalol, hydralazine, or both). Those who had IV nicardipine had significantly less BPV (p = 0.04) and was more likely to attain an SBP goal < 140 mmHg (p < 0.01).

CONCLUSION

Our study suggests patients with ICH who do not receive a nicardipine-based antihypertensive regimen have more BPV, which has been associated with poor clinical outcomes. Prospective, randomized, controlled trials are needed to determine the impact of specific antihypertensive regimens on clinical outcomes.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Poyant JO
Department of Pharmacy Services, Tufts Medical Center, Boston, MA, USA. JPoyant@tuftsmedicalcenter.org. , Boston, USA. JPoyant@tuftsmedicalcenter.org.
Kuper PJ
Department of Pharmacy Services, Mayo Clinic, Rochester, MN, USA.
Mara KC
Department of Biomedical Statistics, Mayo Clinic, Rochester, MN, USA.
Dierkhising RA
Department of Biomedical Statistics, Mayo Clinic, Rochester, MN, USA.
Rabinstein AA
Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Wijdicks EFM
Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Ritchie BM
Department of Pharmacy Services, Mayo Clinic, Rochester, MN, USA.

MeSH

Administration, IntravenousAdultAgedAntihypertensive AgentsBlood PressureCerebral HemorrhageFemaleHumansHydralazineLabetalolMaleMiddle AgedNicardipineRetrospective StudiesTreatment Outcome

Pub Type(s)

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

Language

eng

PubMed ID

30051193

Citation

Poyant, Janelle O., et al. "Nicardipine Reduces Blood Pressure Variability After Spontaneous Intracerebral Hemorrhage." Neurocritical Care, vol. 30, no. 1, 2019, pp. 118-125.
Poyant JO, Kuper PJ, Mara KC, et al. Nicardipine Reduces Blood Pressure Variability After Spontaneous Intracerebral Hemorrhage. Neurocrit Care. 2019;30(1):118-125.
Poyant, J. O., Kuper, P. J., Mara, K. C., Dierkhising, R. A., Rabinstein, A. A., Wijdicks, E. F. M., & Ritchie, B. M. (2019). Nicardipine Reduces Blood Pressure Variability After Spontaneous Intracerebral Hemorrhage. Neurocritical Care, 30(1), 118-125. https://doi.org/10.1007/s12028-018-0582-0
Poyant JO, et al. Nicardipine Reduces Blood Pressure Variability After Spontaneous Intracerebral Hemorrhage. Neurocrit Care. 2019;30(1):118-125. PubMed PMID: 30051193.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nicardipine Reduces Blood Pressure Variability After Spontaneous Intracerebral Hemorrhage. AU - Poyant,Janelle O, AU - Kuper,Philip J, AU - Mara,Kristin C, AU - Dierkhising,Ross A, AU - Rabinstein,Alejandro A, AU - Wijdicks,Eelco F M, AU - Ritchie,Brianne M, PY - 2018/7/28/pubmed PY - 2020/1/10/medline PY - 2018/7/28/entrez KW - Antihypertensive KW - Blood pressure variability KW - Bolus KW - Hydralazine KW - Infusion KW - Intracerebral hemorrhage KW - Labetalol KW - Nicardipine SP - 118 EP - 125 JF - Neurocritical care JO - Neurocrit Care VL - 30 IS - 1 N2 - BACKGROUND: Blood pressure variability (BPV) is an independent predictor for early hematoma expansion, neurologic deterioration, and mortality. There are no studies on the effect of intravenous (IV) antihypertensive drugs on BPV. We sought to determine whether patients have more BPV with certain antihypertensive agents, in particular the effect of IV nicardipine. METHODS: We conducted a single-center, retrospective chart review of individuals diagnosed with spontaneous intracerebral hemorrhage (ICH) receiving labetalol, hydralazine, and/or nicardipine within 24 h of hospital admission to assess the primary endpoint of BPV, defined as the standard deviation of systolic BP, with labetalol and/or hydralazine compared to nicardipine ± labetalol and/or hydralazine. Repeated measures linear regression was performed to compare BPV over 24 h between regimens, and Cox proportional hazards regression was used to compare the time to goal SBP between regimens. RESULTS: Of the 1330 patients screened, 272 were included in our analysis; those included had a mean age of 69 years with 87.9% of Caucasian race. A total of 164 patients received IV bolus antihypertensives alone (labetalol, hydralazine or both), and 108 patients received IV nicardipine with or without additional IV boluses (labetalol, hydralazine, or both). Those who had IV nicardipine had significantly less BPV (p = 0.04) and was more likely to attain an SBP goal < 140 mmHg (p < 0.01). CONCLUSION: Our study suggests patients with ICH who do not receive a nicardipine-based antihypertensive regimen have more BPV, which has been associated with poor clinical outcomes. Prospective, randomized, controlled trials are needed to determine the impact of specific antihypertensive regimens on clinical outcomes. SN - 1556-0961 UR - https://www.unboundmedicine.com/medline/citation/30051193/Nicardipine_Reduces_Blood_Pressure_Variability_After_Spontaneous_Intracerebral_Hemorrhage_ DB - PRIME DP - Unbound Medicine ER -